Lasting Impact of Undergraduate Operating Room Shadowing on Novice Nurses: A ChatGPT-Supported Qualitative Study

Lasting Impact of Undergraduate Operating Room Shadowing on Novice Nurses: A ChatGPT-Supported Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lasting Impact of Undergraduate Operating Room Shadowing on Novice Nurses: A ChatGPT-Supported Qualitative Study Kentaro Hara, Reika Tachibana, Ryosuke Kumashiro, Takahiro Inoue This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6969322/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Sep, 2025 Read the published version in BMC Nursing → Version 1 posted 13 You are reading this latest preprint version Abstract Background Operating room (OR) shadowing allows nursing students to observe high-stakes teamwork and clinical decision-making. However, the emotional and professional impact of such experiences on novice nurses remains underexplored. Methods This qualitative study explored how a single episode of OR shadowing during undergraduate clinical training influenced novice nurses’ emotional responses and professional development. Semi-structured interviews were conducted with six novice nurses within their first year of clinical practice. Transcripts were analyzed using a ChatGPT-assisted thematic and sentiment analysis approach. Semantic clustering and emotion-frequency visualizations were also applied to enhance interpretive transparency. Results Six superordinate themes and 19 subthemes were identified: (1) Communication and Teamwork, (2) Holistic and Empathetic Care, (3) Patient Safety and Ethical Awareness, (4) Professional Identity and Role Formation, (5) Skill Development and Clinical Preparedness, and (6) Transformative and Experiential Learning. Participants expressed a range of emotions—most notably respect, gratitude, admiration, and growth—which were strongly associated with reflections on ethical practice, role modeling, and future aspirations. Visualization techniques revealed that emotionally resonant experiences were often thematically clustered, suggesting shared meaning structures across participants. Despite the brevity of the experience, many participants described lasting effects on their clinical attitudes, ethical awareness, and self-concept as nurses. Conclusions A single OR shadowing experience during undergraduate education can evoke deep emotional responses and support early professional identity formation among novice nurses. The integration of structured reflection or guided debriefing may enhance these effects. Findings support the inclusion of observational experiences, even brief ones, in undergraduate nursing curricula as a means to cultivate ethical sensitivity, interprofessional awareness, and reflective practice. Operating room shadowing Novice nurses Reflective learning Emotional responses Nursing education Figures Figure 1 Figure 2 Background Perioperative nursing refers to the role of supporting patients undergoing surgery to receive safe and optimal care, through collaboration with the medical team and the application of specialized knowledge and skills [1]. In this context, operating room (OR) nurses serve a critical function not only in patient care but also in transmitting practical perioperative knowledge to nursing students during their education [2]. Clinical practicums are a core educational strategy in nursing curricula, aimed at integrating theoretical knowledge and practical skills. These experiences are designed to foster essential competencies such as interpersonal communication, ethical decision-making, and professional self-reflection. Clinical education may also include collaborative learning, team-based learning, and simulation training [3–5]. However, nursing students frequently report stressors during clinical practice, such as unfamiliar hospital environments, perceived inadequacy in fulfilling clinical responsibilities, and a lack of confidence in their knowledge base [6,7]. To mitigate these challenges, Hospital A introduced a shadowing-based practicum in the OR in 2022. Shadowing involves observing the clinical practice of role models and experiencing firsthand how theoretical knowledge is applied in real settings. This method has been recognized as an effective educational approach and is increasingly implemented across institutions [8]. In our previous study (submitted to the Japan Academy of Nursing Research), we qualitatively analyzed the narratives of OR nurses acting as role models and identified the core category of "student guidance." This encompassed subcategories such as “dedication to student instruction,” “perspectives on shadowing,” and “intentional behaviors by nurses.” Twenty-one conceptual codes were identified, suggesting that shadowing enables students to observe perioperative nursing through the lens of professional values, thereby supporting deeper learning and the achievement of educational goals. However, this prior research focused solely on OR nurses’ perspectives, without analyzing the reactions or reflective experiences of nursing students who participated in shadowing. Thus, it remains unclear how shadowing affects students’ self-awareness, professional identity, or personal growth from their own viewpoint. To address this gap, the present study aims to explore the multifaceted impact of shadowing on newly graduated nurses who had experienced it during their clinical practicums. These novice nurses were chosen as participants rather than students immediately post-practicum, in order to assess the lasting professional influences of role model engagement, including identity formation. The anticipated outcomes of this study include insights into the educational effects of shadowing on students’ learning motivation, comprehension of clinical skills, and emotional development. Furthermore, it may inform best practices for integrating shadowing into nursing education and supporting students' transition into professional roles. Research Questions How do novice nurses who experienced shadowing during their operating room clinical practicum describe its impact on their learning and professional development? In what ways has the shadowing experience influenced their self-perception, emotional responses, and role understanding as professional nurses? What elements of the shadowing experience do novice nurses consider most meaningful or formative for their current nursing practice? Methods Study Design and Ethical Considerations This qualitative study explored the impact of operating room shadowing experiences during clinical training on novice nurses. The study was designed and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [9]. Ethical approval was obtained from the Institutional Review Board of the NHO Nagasaki Medical Center (Approval No. 2024016). Written informed consent was obtained from all participants before data collection. Participants and Setting The study recruited 12 novice nurses who had participated in operating room shadowing during their nursing student clinical practicum at Hospital A in 2022. Six participants declined to participate in interviews, resulting in six valid participants (labeled A to F). All participants were within their first year of professional practice and had no prior operating room experience beyond student training. Sampling was purposive to ensure relevance to the research objectives. Data Collection Semi-structured interviews were conducted in Japanese between January and March 2025. Interviews were guided by a structured interview protocol focusing on students’ reflections regarding the shadowing experience, perceived professional growth, and emotional and cognitive responses. Each interview lasted approximately 40–60 minutes and was audio-recorded with consent. Interviews were conducted by the first author, who had no direct hierarchical relationship with the participants. Data Analysis 1. Transcription and Preprocessing All interviews were transcribed verbatim in Japanese and anonymized. Transcripts were segmented into individual utterances for detailed analysis. 2. ChatGPT-Assisted Thematic and Sentiment Analysis (dup: abstract ?) We employed a structured multi-step qualitative analysis combining thematic and sentiment analysis to explore the reflections of novice nurses on their operating room shadowing experience. 1. Transcription and Preprocessing All interviews were transcribed verbatim in Japanese and anonymized to remove identifying information. Transcripts were segmented into discrete utterances to facilitate detailed analysis. 2. ChatGPT-Assisted Thematic and Sentiment Analysis A hybrid human-AI approach was employed to ensure both analytical rigor and interpretive depth. The process involved the following steps: Step 1: Initial coding. Participant utterances were segmented and examined using ChatGPT (GPT-4o), a generative language model developed by OpenAI, to assist in identifying meaningful units related to professional development, reflection, and emotional response. Step 2: Sentiment labeling. Each utterance was labeled with one or more emotions based on a refined emotional taxonomy (e.g., admiration, respect, insight, anxiety, gratitude). Step 3: Thematic coding. Thematic labels were generated inductively and refined through iteration, with themes further grouped into overarching categories to enhance interpretability. Step 4: Researcher triangulation. Two researchers independently reviewed and validated all codes, resolving discrepancies through discussion. All AI-assisted codes were critically evaluated and finalized through human judgment to ensure alignment with the contextual meaning of the data. ChatGPT was used strictly as an analytical aid, not a substitute for human interpretation. All content generated by the model was thoroughly reviewed and refined by the research team. The validity and utility of ChatGPT-assisted analysis in qualitative nursing research have been previously demonstrated by Hara et al. [10], who reported that such approaches enhance coding consistency and provide novel insights when used with appropriate safeguards. 3. Trustworthiness To ensure the credibility and rigor of the study, multiple strategies were employed: Triangulation of data sources and perspectives. Peer debriefing with qualitative research experts. Member checking with selected participants to validate interpretations. Maintenance of an audit trail and analytic memos throughout the research process. Use of ChatGPT for English Proofreading For the English proofreading of this manuscript, we utilized ChatGPT, a large language model developed by OpenAI. ChatGPT contributed to the improvement of grammar, vocabulary, style, and structure, thereby enhancing the quality of the manuscript. Specifically, it provided suggestions to improve the clarity and consistency of the text. Care was taken to ensure that the model's suggestions accurately reflected the researchers' intentions and that technical terms and specialized content were appropriately conveyed. All suggestions and modifications generated by ChatGPT were reviewed and approved by the researchers before being incorporated into the final manuscript. Results 1. Participants Among the 12 eligible novice nurses who had participated in operating room (OR) shadowing during their clinical training, six agreed to take part in the interviews. All six participants were female, within their first year of clinical practice, and held a Bachelor of Nursing degree. Their current clinical units varied, including general surgery, emergency, orthopedic, gynecology, cardiovascular ICU, and mixed medical wards. Each participant had observed a different surgical procedure during their student OR shadowing, such as valve replacement, laparoscopic surgeries, or Cesarean section. Their motivations for becoming nurses were diverse, including personal experiences with illness, interest in acute care or women’s health, and admiration for nursing professionals. Detailed participant characteristics and observed surgeries are shown in Table 1 . Table 1 Participant Characteristics and Shadowing Surgery Experience Participant Clinical Unit Degree Motivation for Becoming a Nurse Surgical Procedure Observed During Shadowing A General Surgery Ward Bachelor of Nursing Inspired by a family member’s illness; interested in acute care Heart valve replacement surgery B Emergency Department Bachelor of Nursing Attracted to the fast-paced nature of emergency care Laparoscopic colectomy C Orthopedic Ward Bachelor of Nursing Admired rehabilitation nurses; interested in physical recovery Total hip replacement surgery D Gynecology Ward Bachelor of Nursing Interested in women's health and wanted to be involved in support Cesarean section E Cardiovascular Intensive Care Unit Bachelor of Nursing Motivated by interest in critical care and advanced medical technology Laparoscopic cholecystectomy F Mixed Medical Ward Bachelor of Nursing Wanted to become a holistic caregiver from an early age Open bowel resection surgery 2. Emergent Themes Thematic analysis revealed six superordinate themes encompassing 19 subthemes, reflecting the participants’ professional reflections, emotional responses, and learning experiences from the OR shadowing: Communication and Teamwork – Participants gained new perspectives on professional communication and silent coordination in high-stakes environments. Holistic and Empathetic Care – Small acts of empathy and the behind-the-scenes work in the OR broadened students’ understanding of care. Patient Safety and Ethical Awareness – Observing protocol adherence, risk mitigation, and respectful practices shaped their sense of professional responsibility. Professional Identity and Role Formation – Participants reflected on the kind of nurse they aspired to become and the roles they could pursue. Skill Development and Clinical Preparedness – The experience fostered confidence, anticipation, and attention to clinical detail applicable to their current practice. Transformative and Experiential Learning – Despite the short duration of the shadowing, the experience had a lasting and transformative impact on participants’ professional views. These themes were not confined to isolated individuals; most were supported by quotes from multiple participants, suggesting shared interpretive patterns across the sample. Each theme was associated with a range of emotional responses such as admiration, insight, gratitude, and motivation. A detailed mapping of themes, subthemes, representative quotes, and coded emotions is provided in Table 2 . Table 2 serves as the analytic core, demonstrating how emotional responses were contextually grounded in reflective content and thematically coded. Table 2 Thematic and Emotional Matrix of Novice Nurses' Reflections on Operating Room Shadowing Superordinate Theme Theme Synthesized Insight Emotion(s) Participant(s) Representative Quote(s) Communication and Teamwork Effective Communication Clarity and brevity in communication, modeled in the OR, shaped participants’ current practices. Intentionality F • Now I try to apply that—especially during handovers or when briefing colleagues. I try to eliminate ambiguity. Professional Communication Professional interactions in the OR served as a model for assertive yet respectful communication. Motivation D • Seeing how the OR nurses communicated... made me want to be more assertive, but still respectful and clear. Teamwork and Communication Participants were inspired by the silent, seamless coordination among OR staff, redefining what communication in nursing can mean. Admiration C • The scrub nurse and the circulating nurse worked together... they seemed to communicate with minimal words but always knew what needed to be done. Holistic and Empathetic Care Awareness of Hidden Labor in Nursing Participants became aware of the behind-the-scenes complexity and preparation involved in OR nursing, which had previously gone unnoticed. Admiration A • I was surprised at how much preparation is done behind the scenes before the surgery even starts. Empathy and Patient-Centeredness Even in a highly technical environment, small gestures of empathy stood out and reshaped how students defined 'care'. Admiration B • They played the patient’s favorite music before the surgery, and I realized the staff cared about the patient’s comfort. Holistic View of Care Students gained a broader understanding of continuity in care, bridging pre-, intra-, and postoperative nursing. Insight B • In the OR, I learned about continuity of care from the operating room to the ward. Patient Safety and Ethical Awareness Ethical Awareness and Dignity Even unconscious patients were treated with utmost respect, redefining the meaning of dignity in care. Empathy D • They carefully covered the patient's body to protect their privacy... I noticed it and felt that was a true act of respect. Ethical Practice and Consent The 'time-out' ritual was experienced as a moment of collective ethical seriousness. Reverence F • There was a brief pause before the surgery... it was formal but also deeply respectful. Ethical Responsibility Protocol adherence was reframed not as routine but as an ethical imperative. Respect E • In the OR, I saw how critical it is to follow protocols and maintain a sterile environment. Patient Safety Awareness Small corrective actions highlighted the critical role of vigilance in patient safety. Respect D • She noticed that the patient’s arm wasn’t properly positioned and adjusted it... I realized how much patient safety depends on those little things. Patient Safety and Risk Awareness The emphasis on injury prevention and procedural checks in the OR inspired a lasting appreciation for vigilance in nursing practice. Respect A • I clearly remember seeing the surgical nurse check the patient’s position multiple times. Team-based Safety Culture The shared responsibility among OR staff stood out as a model for distributed safety leadership. Respect F • I saw how each person’s role contributes to patient safety. Vigilance and Monitoring The OR revealed a silent yet constant vigilance that shaped students’ sense of clinical attentiveness. Respect C • They were watching skin color, monitoring vital signs, and checking the position of the body to prevent pressure injuries. Patient Safety Culture Witnessing protocols like 'time-out' gave students a tangible model of system-based safety and collective accountability. Respect B • Everyone stopped what they were doing... and confirmed the patient’s identity, the procedure, and the surgical site. Professional Identity and Role Formation Career Path Influence OR exposure nudged some participants toward acute care and surgical settings. Motivation E • I listed a surgical ward as my first choice... I wanted to stay close to that kind of environment. Career Vision and Identity Several participants linked their OR experiences to preferences for future work settings and career goals. Clarity C • It gave me a clearer image of what kind of nurse I want to become. Professional Identity Development The transition from 'doing tasks' to 'being a professional' was a defining effect of OR exposure. Growth F • It helped me move from just ‘doing tasks’ to ‘being a professional.’ Professional Identity Formation The OR fostered reflection on what kind of nurse participants aspired to become. Growth C • I used to think that being kind and listening to patients was enough. But now, I also think a nurse needs to be organized, prepared, and a strong advocate for patient safety. Professional Role Understanding Shadowing experiences expanded students' understanding of the multifaceted and highly accountable role of OR nurses. Growth A • When the nurse explained how she documents everything... it made me realize how multifaceted and responsible the role is. Professionalism and Responsibility The way OR nurses coordinated and checked procedures inspired a new model of professionalism. Admiration F • The way she double-checked everything and communicated with the team impressed me. Responsibility and Attention to Detail Every small act—like counting instruments—was revealed to carry enormous responsibility. Admiration E • The care and attention she put into it really stuck with me. It made me realize how much responsibility OR nurses have. Professional Development Many participants described a shift in their attitudes toward nursing practice, feeling inspired to be more attentive and responsible. Motivation A • Seeing their role... gave me a lot of respect for them. It made me want to be more attentive in my own practice, too. Skill Development and Clinical Preparedness Confidence in Clinical Practice The experience gave participants confidence in practical preparations and organization. Confidence E • Even though I don’t work in the OR now, that awareness of safety checks and preparation steps helps me stay calm and organized. Proactive Skill and Anticipation The anticipation skills of OR nurses impressed students and modeled expert-level foresight. Awe E • The nurse's role in anticipating the surgeon’s needs and preparing instruments... was like watching a well-rehearsed performance. Technical Skill and Precision Participants noted how the OR required speed and accuracy, often delivered with grace under pressure. Admiration D • I was amazed by their precision and speed. They were always one step ahead. Transformative and Experiential Learning Applied Learning and Retention Exposure to real clinical scenarios anchored theoretical knowledge, especially for licensing exam preparation. Confidence B • I found the acute care section of the national exam easier to understand... because I had seen it in practice. Expanded Nursing Perspective The experience revealed that nursing encompasses both human warmth and technical precision. Growth D • It taught me that nursing is multifaceted, and that I want to become a nurse who can provide care with both heart and precision. Link Between Experience and Theory Real-life observation helped dissolve the abstraction of textbook knowledge. Confidence C • Because I had seen real surgical settings, the scenarios in the textbooks didn’t feel abstract. I could visualize them better. Significance of Brief Experiences Even short shadowing experiences made deep impressions, affirming their educational impact. Gratitude B • It was a short experience, but it left a deep impact. I hope other students can benefit from similar experiences. Transformative Learning The OR shadowing was not just educational—it was transformational, embedding long-term values and awareness. Gratitude A • It wasn’t just an observation—it was a learning experience that stays with me even now. 3. Emotional and Semantic Patterns Participants’ reflections revealed a rich diversity of emotional responses across themes. Figure 1 presents a bar chart displaying the frequency of each emotion identified in this study, categorized by superordinate theme. The horizontal axis lists the identified emotions, while the vertical axis indicates the number of utterances coded with each emotion. The most frequently observed emotion was “Respect” , particularly in connection with Patient Safety and Ethical Awareness . “Gratitude” and “Growth” were also prominent, especially within the themes of Transformative and Experiential Learning and Professional Identity and Role Formation . These distributions highlight the emotional salience and thematic relevance of shadowing experiences. Figure 2 shows a semantic similarity map of representative participant utterances. Using two-dimensional sentence embeddings, each quote is visualized as a data point. The color of each point denotes the associated theme, and the shape reflects the emotion coded for that utterance. Quotes expressing similar emotional and thematic content tended to cluster together. For instance, reflections related to awe or reverence often appeared near Patient Safety and Ethical Awareness , while confidence and growth-oriented utterances clustered with Skill Development and Role Formation . This map illustrates how emotional tone and thematic focus are intertwined in novice nurses' interpretive experiences. These emotional responses were not isolated reactions but often contributed to participants’ evolving sense of professional identity, preparedness, and value orientation in clinical settings. The trustworthiness of the findings was reinforced through peer debriefing, triangulation of interpretations, and member checking with participants to ensure interpretive accuracy. Discussion This qualitative study explored how a single episode of operating room (OR) shadowing during undergraduate clinical training shaped novice nurses’ emotional responses, professional development, and ethical awareness. The findings indicate that even a brief observational experience can serve as a powerful trigger for reflective learning, helping students internalize professional values and envision their future roles as nurses. These outcomes resonate with prior research highlighting the transformative potential of situated and experiential learning in clinical education [11, 12]. This is consistent with Vygotsky’s sociocultural theory, in which learning occurs through participation in authentic social activities and interaction with more experienced practitioners, making the OR a powerful “zone of proximal development” for novice nurses. Our findings align with previous studies that emphasize the emotional salience of learning in high-stakes clinical environments such as the OR and intensive care settings. These contexts are often charged with tension and teamwork, offering unique insights into interprofessional dynamics, patient safety protocols, and ethical responsibility [13–15]. The emotional spectrum observed in this study—from admiration and respect to anxiety and gratitude—underscores how immersive experiences can provoke multidimensional learning, consistent with theories of emotional-cognitive integration in health professions education [16, 17]. Furthermore, research in cognitive psychology suggests that emotionally charged events are more likely to be retained in long-term memory, implying that shadowing experiences can have enduring pedagogical impact when paired with emotional salience. Unlike earlier studies that primarily focused on the acquisition of procedural knowledge or technical skills through shadowing [18, 19], our study emphasizes how students’ exposure to non-technical aspects—such as empathetic gestures, silent communication, and patient-centered care—can foster deeper ethical and professional reflection. This shift aligns with contemporary trends in nursing education that advocate for the cultivation of moral sensitivity and reflective practice alongside clinical competence [20]. From an educational standpoint, these findings suggest that even a single shadowing experience can catalyze lasting changes in students’ attitudes and professional identity. These insights also speak to the ongoing need for smoother academic-to-practice transitions in nursing, suggesting that emotionally reflective shadowing may act as a bridge between theoretical instruction and the realities of patient care. The observed linkage between specific emotions (e.g., admiration, respect) and thematic domains (e.g., patient safety, role formation) suggests that emotional resonance may function as an anchor for integrating abstract values with lived experience [13, 14]. Structured debriefing or guided reflection following shadowing may further enhance this process, a recommendation supported by research on experiential learning debriefs [21, 22]. Methodologically, this study extends the work of Hara et al. [10], who demonstrated the utility of ChatGPT-assisted thematic and emotional analysis in nursing education. By incorporating sentence-level semantic clustering and cross-participant emotional mapping, we were able to visualize and triangulate shared patterns of meaning. This multi-modal analysis helped reduce investigator bias and enhanced transparency in thematic interpretation, which is particularly relevant in exploratory studies with small samples [10]. Moreover, the use of AI-assisted methods such as ChatGPT may hold promise for scalable, replicable thematic analyses in nursing pedagogy, particularly where faculty resources for qualitative analysis are limited. Nevertheless, the study has several limitations. The emotional labeling process—while supported by a refined taxonomy and human validation—remains interpretive and context-dependent. Additionally, all participants in this study identified as female, which may have influenced both the emotional expressions and thematic interpretations. Gendered dimensions of empathy, communication, and ethical engagement in clinical settings warrant further investigation. Moreover, the sample was drawn from a single cohort at one institution, potentially limiting transferability. Future research should explore how repeated or longitudinal shadowing opportunities influence professional identity development, emotional resilience, and ethical reasoning in nursing students. Conclusions This study found that even a single episode of operating room (OR) shadowing during undergraduate nursing education can leave a lasting impact on novice nurses’ emotional engagement, ethical awareness, and professional identity. Participants internalized values such as teamwork, empathy, and patient safety, often through emotionally resonant moments. The findings support the integration of brief but meaningful shadowing experiences and guided reflection into nursing education. These approaches may effectively bridge theoretical learning with real-world practice, promoting deeper professional growth. Declarations Ethical approval and consent to participate This study was approved by the Ethics Committee of Nagasaki Medical Center (Approval No. 2024016). This study does not involve a clinical trial; therefore, a clinical trial number is not applicable. All methods were performed in accordance with relevant guidelines and regulations. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki (1964) and its amendments. All observational protocols were approved by the institutional and licensing committees of Nagasaki Medical Center. Informed consent was obtained from all participants prior to their inclusion in the study. Participants were provided with detailed explanations of the study's purpose, methods, risks, and benefits to ensure their voluntary participation. Privacy and confidentiality of the participants were strictly protected, and the recorded data and interview content were anonymized and handled with the utmost care to ensure data security. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Acknowledgments We gratefully acknowledge the work of the past and present members of our medical center. Competing interests The authors declare no competing interests or conflicts of interest. Funding This study received no specific funding from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions Kentaro Hara conceptualized and designed the study, supervised data collection and analysis, and led the manuscript writing. Reika Tachibana contributed to participant recruitment, conducted interviews, and supported data interpretation. Ryosuke Kumashiro assisted in thematic coding, data organization, and provided critical revisions to the manuscript. Takahiro Inoue offered methodological guidance on qualitative analysis, supervised the integration of ChatGPT-assisted procedures, and contributed to manuscript refinement. All authors reviewed and approved the final version of the manuscript. References Cochran K. Guidelines in practice: prevention of unintentionally retained surgical items. AORN J . 2022;116(5):427–40. https://doi.org/10.1002/aorn.13804 Totur Dikmen B, Bayraktar N. Nursing students' experiences related to operating room practice: a qualitative study. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6969322","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":484770883,"identity":"eca615fd-738c-418a-abee-2eaa18fa918c","order_by":0,"name":"Kentaro Hara","email":"data:image/png;base64,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","orcid":"","institution":"Kumamoto University","correspondingAuthor":true,"prefix":"","firstName":"Kentaro","middleName":"","lastName":"Hara","suffix":""},{"id":484770884,"identity":"5c4d4f9b-7bd4-4fc4-9523-7d0a2b724eda","order_by":1,"name":"Reika Tachibana","email":"","orcid":"","institution":"NHO Nagasaki Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Reika","middleName":"","lastName":"Tachibana","suffix":""},{"id":484770885,"identity":"a12fa5e9-d20d-4ef2-adec-c126fa2ca2be","order_by":2,"name":"Ryosuke Kumashiro","email":"","orcid":"","institution":"NHO Nagasaki Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ryosuke","middleName":"","lastName":"Kumashiro","suffix":""},{"id":484770886,"identity":"ebcfad0f-a902-4cac-9ba8-39f0f155881b","order_by":3,"name":"Takahiro Inoue","email":"","orcid":"","institution":"Chiba University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Takahiro","middleName":"","lastName":"Inoue","suffix":""}],"badges":[],"createdAt":"2025-06-25 00:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6969322/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6969322/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12912-025-03770-x","type":"published","date":"2025-09-02T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86673190,"identity":"4b18a85a-ff5e-455d-a2cc-65f894aefa53","added_by":"auto","created_at":"2025-07-14 11:45:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":87622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEmotion frequency by superordinate theme\u003c/strong\u003e\u003cbr\u003e\nA bar chart displaying the number of utterances associated with each emotion across six superordinate themes. Colors indicate themes: Communication and Teamwork, Holistic and Empathetic Care, Patient Safety and Ethical Awareness, Professional Identity and Role Formation, Skill Development and Clinical Preparedness, and Transformative and Experiential Learning.\u003c/p\u003e","description":"","filename":"Figure1.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6969322/v1/cf56bf5514cf8361948f6355.jpg"},{"id":86674667,"identity":"012cc302-ace3-4b56-973e-9531cdd37ea2","added_by":"auto","created_at":"2025-07-14 11:53:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":301958,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSemantic similarity map of reflective utterances\u003c/strong\u003e\u003cbr\u003e\nA two-dimensional semantic similarity map of representative participant quotes. Each point represents one utterance. Colors denote the associated superordinate theme, and shapes indicate the emotion expressed. Quotes with similar emotional and thematic content are clustered together, illustrating patterns in novice nurses’ reflective interpretations of operating room shadowing.\u003c/p\u003e","description":"","filename":"Figure2.tiff.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6969322/v1/37cbef37b016e18ea7789028.jpg"},{"id":90827884,"identity":"2bbeba3f-50a9-4455-9e9a-f0dbe255e8b9","added_by":"auto","created_at":"2025-09-08 16:02:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1698562,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6969322/v1/54952813-4946-4e05-9e73-a6577253f1b3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Lasting Impact of Undergraduate Operating Room Shadowing on Novice Nurses: A ChatGPT-Supported Qualitative Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePerioperative nursing refers to the role of supporting patients undergoing surgery to receive safe and optimal care, through collaboration with the medical team and the application of specialized knowledge and skills [1]. In this context, operating room (OR) nurses serve a critical function not only in patient care but also in transmitting practical perioperative knowledge to nursing students during their education [2].\u003c/p\u003e\u003cp\u003eClinical practicums are a core educational strategy in nursing curricula, aimed at integrating theoretical knowledge and practical skills. These experiences are designed to foster essential competencies such as interpersonal communication, ethical decision-making, and professional self-reflection. Clinical education may also include collaborative learning, team-based learning, and simulation training [3\u0026ndash;5]. However, nursing students frequently report stressors during clinical practice, such as unfamiliar hospital environments, perceived inadequacy in fulfilling clinical responsibilities, and a lack of confidence in their knowledge base [6,7].\u003c/p\u003e\u003cp\u003eTo mitigate these challenges, Hospital A introduced a shadowing-based practicum in the OR in 2022. Shadowing involves observing the clinical practice of role models and experiencing firsthand how theoretical knowledge is applied in real settings. This method has been recognized as an effective educational approach and is increasingly implemented across institutions [8].\u003c/p\u003e\u003cp\u003eIn our previous study (submitted to the Japan Academy of Nursing Research), we qualitatively analyzed the narratives of OR nurses acting as role models and identified the core category of \"student guidance.\" This encompassed subcategories such as \u0026ldquo;dedication to student instruction,\u0026rdquo; \u0026ldquo;perspectives on shadowing,\u0026rdquo; and \u0026ldquo;intentional behaviors by nurses.\u0026rdquo; Twenty-one conceptual codes were identified, suggesting that shadowing enables students to observe perioperative nursing through the lens of professional values, thereby supporting deeper learning and the achievement of educational goals.\u003c/p\u003e\u003cp\u003eHowever, this prior research focused solely on OR nurses\u0026rsquo; perspectives, without analyzing the reactions or reflective experiences of nursing students who participated in shadowing. Thus, it remains unclear how shadowing affects students\u0026rsquo; self-awareness, professional identity, or personal growth from their own viewpoint.\u003c/p\u003e\u003cp\u003eTo address this gap, the present study aims to explore the multifaceted impact of shadowing on newly graduated nurses who had experienced it during their clinical practicums. These novice nurses were chosen as participants rather than students immediately post-practicum, in order to assess the lasting professional influences of role model engagement, including identity formation.\u003c/p\u003e\u003cp\u003eThe anticipated outcomes of this study include insights into the educational effects of shadowing on students\u0026rsquo; learning motivation, comprehension of clinical skills, and emotional development. Furthermore, it may inform best practices for integrating shadowing into nursing education and supporting students' transition into professional roles.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Questions\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eHow do novice nurses who experienced shadowing during their operating room clinical practicum describe its impact on their learning and professional development?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIn what ways has the shadowing experience influenced their self-perception, emotional responses, and role understanding as professional nurses?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eWhat elements of the shadowing experience do novice nurses consider most meaningful or formative for their current nursing practice?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design and Ethical Considerations\u003c/h2\u003e\u003cp\u003eThis qualitative study explored the impact of operating room shadowing experiences during clinical training on novice nurses. The study was designed and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist [9]. Ethical approval was obtained from the Institutional Review Board of the NHO Nagasaki Medical Center (Approval No. 2024016). Written informed consent was obtained from all participants before data collection.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants and Setting\u003c/h3\u003e\n\u003cp\u003eThe study recruited 12 novice nurses who had participated in operating room shadowing during their nursing student clinical practicum at Hospital A in 2022. Six participants declined to participate in interviews, resulting in six valid participants (labeled A to F). All participants were within their first year of professional practice and had no prior operating room experience beyond student training. Sampling was purposive to ensure relevance to the research objectives.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eSemi-structured interviews were conducted in Japanese between January and March 2025. Interviews were guided by a structured interview protocol focusing on students\u0026rsquo; reflections regarding the shadowing experience, perceived professional growth, and emotional and cognitive responses. Each interview lasted approximately 40\u0026ndash;60 minutes and was audio-recorded with consent. Interviews were conducted by the first author, who had no direct hierarchical relationship with the participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Analysis\u003c/b\u003e\u003c/p\u003e\n\u003ch3\u003e1. Transcription and Preprocessing\u003c/h3\u003e\n\u003cp\u003eAll interviews were transcribed verbatim in Japanese and anonymized. Transcripts were segmented into individual utterances for detailed analysis.\u003c/p\u003e\n\u003ch3\u003e2. ChatGPT-Assisted Thematic and Sentiment Analysis (dup: abstract ?)\u003c/h3\u003e\n\u003cp\u003eWe employed a structured multi-step qualitative analysis combining thematic and sentiment analysis to explore the reflections of novice nurses on their operating room shadowing experience.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1. Transcription and Preprocessing\u003c/h2\u003e\u003cp\u003eAll interviews were transcribed verbatim in Japanese and anonymized to remove identifying information. Transcripts were segmented into discrete utterances to facilitate detailed analysis.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e2. ChatGPT-Assisted Thematic and Sentiment Analysis\u003c/h3\u003e\n\u003cp\u003eA hybrid human-AI approach was employed to ensure both analytical rigor and interpretive depth. The process involved the following steps:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStep 1: Initial coding.\u003c/b\u003e Participant utterances were segmented and examined using ChatGPT (GPT-4o), a generative language model developed by OpenAI, to assist in identifying meaningful units related to professional development, reflection, and emotional response.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStep 2: Sentiment labeling.\u003c/b\u003e Each utterance was labeled with one or more emotions based on a refined emotional taxonomy (e.g., admiration, respect, insight, anxiety, gratitude).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStep 3: Thematic coding.\u003c/b\u003e Thematic labels were generated inductively and refined through iteration, with themes further grouped into overarching categories to enhance interpretability.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStep 4: Researcher triangulation.\u003c/b\u003e Two researchers independently reviewed and validated all codes, resolving discrepancies through discussion. All AI-assisted codes were critically evaluated and finalized through human judgment to ensure alignment with the contextual meaning of the data.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eChatGPT was used strictly as an analytical aid, not a substitute for human interpretation. All content generated by the model was thoroughly reviewed and refined by the research team. The validity and utility of ChatGPT-assisted analysis in qualitative nursing research have been previously demonstrated by Hara et al. [10], who reported that such approaches enhance coding consistency and provide novel insights when used with appropriate safeguards.\u003c/p\u003e\n\u003ch3\u003e3. Trustworthiness\u003c/h3\u003e\n\u003cp\u003eTo ensure the credibility and rigor of the study, multiple strategies were employed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTriangulation of data sources and perspectives.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePeer debriefing with qualitative research experts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMember checking with selected participants to validate interpretations.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eMaintenance of an audit trail and analytic memos throughout the research process.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eUse of ChatGPT for English Proofreading\u003c/h2\u003e\u003cp\u003eFor the English proofreading of this manuscript, we utilized ChatGPT, a large language model developed by OpenAI. ChatGPT contributed to the improvement of grammar, vocabulary, style, and structure, thereby enhancing the quality of the manuscript. Specifically, it provided suggestions to improve the clarity and consistency of the text. Care was taken to ensure that the model's suggestions accurately reflected the researchers' intentions and that technical terms and specialized content were appropriately conveyed. All suggestions and modifications generated by ChatGPT were reviewed and approved by the researchers before being incorporated into the final manuscript.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e1. Participants\u003c/h2\u003e\u003cp\u003e Among the 12 eligible novice nurses who had participated in operating room (OR) shadowing during their clinical training, six agreed to take part in the interviews. All six participants were female, within their first year of clinical practice, and held a Bachelor of Nursing degree. Their current clinical units varied, including general surgery, emergency, orthopedic, gynecology, cardiovascular ICU, and mixed medical wards. Each participant had observed a different surgical procedure during their student OR shadowing, such as valve replacement, laparoscopic surgeries, or Cesarean section. Their motivations for becoming nurses were diverse, including personal experiences with illness, interest in acute care or women\u0026rsquo;s health, and admiration for nursing professionals. Detailed participant characteristics and observed surgeries are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant Characteristics and Shadowing Surgery Experience\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical Unit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDegree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotivation for Becoming a Nurse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSurgical Procedure Observed During Shadowing\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGeneral Surgery Ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInspired by a family member\u0026rsquo;s illness; interested in acute care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHeart valve replacement surgery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmergency Department\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAttracted to the fast-paced nature of emergency care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLaparoscopic colectomy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthopedic Ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmired rehabilitation nurses; interested in physical recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal hip replacement surgery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGynecology Ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInterested in women's health and wanted to be involved in support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCesarean section\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCardiovascular Intensive Care Unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotivated by interest in critical care and advanced medical technology\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLaparoscopic cholecystectomy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMixed Medical Ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBachelor of Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWanted to become a holistic caregiver from an early age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOpen bowel resection surgery\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e2. Emergent Themes\u003c/h2\u003e\u003cp\u003eThematic analysis revealed six superordinate themes encompassing 19 subthemes, reflecting the participants\u0026rsquo; professional reflections, emotional responses, and learning experiences from the OR shadowing:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eCommunication and Teamwork\u003c/b\u003e \u0026ndash; Participants gained new perspectives on professional communication and silent coordination in high-stakes environments.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eHolistic and Empathetic Care\u003c/b\u003e \u0026ndash; Small acts of empathy and the behind-the-scenes work in the OR broadened students\u0026rsquo; understanding of care.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePatient Safety and Ethical Awareness\u003c/b\u003e \u0026ndash; Observing protocol adherence, risk mitigation, and respectful practices shaped their sense of professional responsibility.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eProfessional Identity and Role Formation\u003c/b\u003e \u0026ndash; Participants reflected on the kind of nurse they aspired to become and the roles they could pursue.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eSkill Development and Clinical Preparedness\u003c/b\u003e \u0026ndash; The experience fostered confidence, anticipation, and attention to clinical detail applicable to their current practice.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eTransformative and Experiential Learning\u003c/b\u003e \u0026ndash; Despite the short duration of the shadowing, the experience had a lasting and transformative impact on participants\u0026rsquo; professional views.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThese themes were not confined to isolated individuals; most were supported by quotes from multiple participants, suggesting shared interpretive patterns across the sample. Each theme was associated with a range of emotional responses such as admiration, insight, gratitude, and motivation. A detailed mapping of themes, subthemes, representative quotes, and coded emotions is provided in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e serves as the analytic core, demonstrating how emotional responses were contextually grounded in reflective content and thematically coded.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThematic and Emotional Matrix of Novice Nurses' Reflections on Operating Room Shadowing\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuperordinate Theme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSynthesized Insight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmotion(s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eParticipant(s)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRepresentative Quote(s)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eCommunication and Teamwork\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEffective Communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClarity and brevity in communication, modeled in the OR, shaped participants\u0026rsquo; current practices.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntentionality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Now I try to apply that\u0026mdash;especially during handovers or when briefing colleagues. I try to eliminate ambiguity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProfessional interactions in the OR served as a model for assertive yet respectful communication.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Seeing how the OR nurses communicated... made me want to be more assertive, but still respectful and clear.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeamwork and Communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipants were inspired by the silent, seamless coordination among OR staff, redefining what communication in nursing can mean.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; The scrub nurse and the circulating nurse worked together... they seemed to communicate with minimal words but always knew what needed to be done.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHolistic and Empathetic Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAwareness of Hidden Labor in Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipants became aware of the behind-the-scenes complexity and preparation involved in OR nursing, which had previously gone unnoticed.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I was surprised at how much preparation is done behind the scenes before the surgery even starts.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmpathy and Patient-Centeredness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEven in a highly technical environment, small gestures of empathy stood out and reshaped how students defined 'care'.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; They played the patient\u0026rsquo;s favorite music before the surgery, and I realized the staff cared about the patient\u0026rsquo;s comfort.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHolistic View of Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudents gained a broader understanding of continuity in care, bridging pre-, intra-, and postoperative nursing.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInsight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; In the OR, I learned about continuity of care from the operating room to the ward.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003ePatient Safety and Ethical Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthical Awareness and Dignity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEven unconscious patients were treated with utmost respect, redefining the meaning of dignity in care.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmpathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; They carefully covered the patient's body to protect their privacy... I noticed it and felt that was a true act of respect.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthical Practice and Consent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe 'time-out' ritual was experienced as a moment of collective ethical seriousness.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReverence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; There was a brief pause before the surgery... it was formal but also deeply respectful.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthical Responsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProtocol adherence was reframed not as routine but as an ethical imperative.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; In the OR, I saw how critical it is to follow protocols and maintain a sterile environment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Safety Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSmall corrective actions highlighted the critical role of vigilance in patient safety.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; She noticed that the patient\u0026rsquo;s arm wasn\u0026rsquo;t properly positioned and adjusted it... I realized how much patient safety depends on those little things.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Safety and Risk Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe emphasis on injury prevention and procedural checks in the OR inspired a lasting appreciation for vigilance in nursing practice.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I clearly remember seeing the surgical nurse check the patient\u0026rsquo;s position multiple times.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeam-based Safety Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe shared responsibility among OR staff stood out as a model for distributed safety leadership.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I saw how each person\u0026rsquo;s role contributes to patient safety.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eVigilance and Monitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe OR revealed a silent yet constant vigilance that shaped students\u0026rsquo; sense of clinical attentiveness.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; They were watching skin color, monitoring vital signs, and checking the position of the body to prevent pressure injuries.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Safety Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWitnessing protocols like 'time-out' gave students a tangible model of system-based safety and collective accountability.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespect\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Everyone stopped what they were doing... and confirmed the patient\u0026rsquo;s identity, the procedure, and the surgical site.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003eProfessional Identity and Role Formation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer Path Influence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR exposure nudged some participants toward acute care and surgical settings.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I listed a surgical ward as my first choice... I wanted to stay close to that kind of environment.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer Vision and Identity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSeveral participants linked their OR experiences to preferences for future work settings and career goals.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClarity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; It gave me a clearer image of what kind of nurse I want to become.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Identity Development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe transition from 'doing tasks' to 'being a professional' was a defining effect of OR exposure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGrowth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; It helped me move from just \u0026lsquo;doing tasks\u0026rsquo; to \u0026lsquo;being a professional.\u0026rsquo;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Identity Formation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe OR fostered reflection on what kind of nurse participants aspired to become.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGrowth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I used to think that being kind and listening to patients was enough. But now, I also think a nurse needs to be organized, prepared, and a strong advocate for patient safety.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Role Understanding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eShadowing experiences expanded students' understanding of the multifaceted and highly accountable role of OR nurses.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGrowth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; When the nurse explained how she documents everything... it made me realize how multifaceted and responsible the role is.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessionalism and Responsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe way OR nurses coordinated and checked procedures inspired a new model of professionalism.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; The way she double-checked everything and communicated with the team impressed me.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResponsibility and Attention to Detail\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvery small act\u0026mdash;like counting instruments\u0026mdash;was revealed to carry enormous responsibility.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; The care and attention she put into it really stuck with me. It made me realize how much responsibility OR nurses have.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMany participants described a shift in their attitudes toward nursing practice, feeling inspired to be more attentive and responsible.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Seeing their role... gave me a lot of respect for them. It made me want to be more attentive in my own practice, too.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSkill Development and Clinical Preparedness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConfidence in Clinical Practice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe experience gave participants confidence in practical preparations and organization.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConfidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Even though I don\u0026rsquo;t work in the OR now, that awareness of safety checks and preparation steps helps me stay calm and organized.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProactive Skill and Anticipation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe anticipation skills of OR nurses impressed students and modeled expert-level foresight.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAwe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; The nurse's role in anticipating the surgeon\u0026rsquo;s needs and preparing instruments... was like watching a well-rehearsed performance.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTechnical Skill and Precision\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipants noted how the OR required speed and accuracy, often delivered with grace under pressure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmiration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I was amazed by their precision and speed. They were always one step ahead.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eTransformative and Experiential Learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eApplied Learning and Retention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExposure to real clinical scenarios anchored theoretical knowledge, especially for licensing exam preparation.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConfidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; I found the acute care section of the national exam easier to understand... because I had seen it in practice.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExpanded Nursing Perspective\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe experience revealed that nursing encompasses both human warmth and technical precision.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGrowth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; It taught me that nursing is multifaceted, and that I want to become a nurse who can provide care with both heart and precision.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLink Between Experience and Theory\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReal-life observation helped dissolve the abstraction of textbook knowledge.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConfidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; Because I had seen real surgical settings, the scenarios in the textbooks didn\u0026rsquo;t feel abstract. I could visualize them better.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSignificance of Brief Experiences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEven short shadowing experiences made deep impressions, affirming their educational impact.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGratitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; It was a short experience, but it left a deep impact. I hope other students can benefit from similar experiences.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransformative Learning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe OR shadowing was not just educational\u0026mdash;it was transformational, embedding long-term values and awareness.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eGratitude\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026bull; It wasn\u0026rsquo;t just an observation\u0026mdash;it was a learning experience that stays with me even now.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3. Emotional and Semantic Patterns\u003c/h2\u003e\u003cp\u003eParticipants\u0026rsquo; reflections revealed a rich diversity of emotional responses across themes. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a bar chart displaying the frequency of each emotion identified in this study, categorized by superordinate theme. The horizontal axis lists the identified emotions, while the vertical axis indicates the number of utterances coded with each emotion. The most frequently observed emotion was \u003cb\u003e\u0026ldquo;Respect\u0026rdquo;\u003c/b\u003e, particularly in connection with \u003cb\u003ePatient Safety and Ethical Awareness\u003c/b\u003e. \u003cb\u003e\u0026ldquo;Gratitude\u0026rdquo;\u003c/b\u003e and \u003cb\u003e\u0026ldquo;Growth\u0026rdquo;\u003c/b\u003e were also prominent, especially within the themes of \u003cb\u003eTransformative and Experiential Learning\u003c/b\u003e and \u003cb\u003eProfessional Identity and Role Formation\u003c/b\u003e. These distributions highlight the emotional salience and thematic relevance of shadowing experiences.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows a semantic similarity map of representative participant utterances. Using two-dimensional sentence embeddings, each quote is visualized as a data point. The color of each point denotes the associated theme, and the shape reflects the emotion coded for that utterance. Quotes expressing similar emotional and thematic content tended to cluster together. For instance, reflections related to \u003cb\u003eawe\u003c/b\u003e or \u003cb\u003ereverence\u003c/b\u003e often appeared near \u003cb\u003ePatient Safety and Ethical Awareness\u003c/b\u003e, while \u003cb\u003econfidence\u003c/b\u003e and \u003cb\u003egrowth-oriented\u003c/b\u003e utterances clustered with \u003cb\u003eSkill Development and Role Formation\u003c/b\u003e. This map illustrates how emotional tone and thematic focus are intertwined in novice nurses' interpretive experiences.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e These emotional responses were not isolated reactions but often contributed to participants\u0026rsquo; evolving sense of professional identity, preparedness, and value orientation in clinical settings. The trustworthiness of the findings was reinforced through peer debriefing, triangulation of interpretations, and member checking with participants to ensure interpretive accuracy.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study explored how a single episode of operating room (OR) shadowing during undergraduate clinical training shaped novice nurses\u0026rsquo; emotional responses, professional development, and ethical awareness. The findings indicate that even a brief observational experience can serve as a powerful trigger for reflective learning, helping students internalize professional values and envision their future roles as nurses. These outcomes resonate with prior research highlighting the transformative potential of situated and experiential learning in clinical education [11, 12]. This is consistent with Vygotsky\u0026rsquo;s sociocultural theory, in which learning occurs through participation in authentic social activities and interaction with more experienced practitioners, making the OR a powerful \u0026ldquo;zone of proximal development\u0026rdquo; for novice nurses.\u003c/p\u003e\u003cp\u003eOur findings align with previous studies that emphasize the emotional salience of learning in high-stakes clinical environments such as the OR and intensive care settings. These contexts are often charged with tension and teamwork, offering unique insights into interprofessional dynamics, patient safety protocols, and ethical responsibility [13\u0026ndash;15]. The emotional spectrum observed in this study\u0026mdash;from admiration and respect to anxiety and gratitude\u0026mdash;underscores how immersive experiences can provoke multidimensional learning, consistent with theories of emotional-cognitive integration in health professions education [16, 17]. Furthermore, research in cognitive psychology suggests that emotionally charged events are more likely to be retained in long-term memory, implying that shadowing experiences can have enduring pedagogical impact when paired with emotional salience.\u003c/p\u003e\u003cp\u003eUnlike earlier studies that primarily focused on the acquisition of procedural knowledge or technical skills through shadowing [18, 19], our study emphasizes how students\u0026rsquo; exposure to non-technical aspects\u0026mdash;such as empathetic gestures, silent communication, and patient-centered care\u0026mdash;can foster deeper ethical and professional reflection. This shift aligns with contemporary trends in nursing education that advocate for the cultivation of moral sensitivity and reflective practice alongside clinical competence [20].\u003c/p\u003e\u003cp\u003eFrom an educational standpoint, these findings suggest that even a single shadowing experience can catalyze lasting changes in students\u0026rsquo; attitudes and professional identity. These insights also speak to the ongoing need for smoother academic-to-practice transitions in nursing, suggesting that emotionally reflective shadowing may act as a bridge between theoretical instruction and the realities of patient care. The observed linkage between specific emotions (e.g., admiration, respect) and thematic domains (e.g., patient safety, role formation) suggests that emotional resonance may function as an anchor for integrating abstract values with lived experience [13, 14]. Structured debriefing or guided reflection following shadowing may further enhance this process, a recommendation supported by research on experiential learning debriefs [21, 22].\u003c/p\u003e\u003cp\u003eMethodologically, this study extends the work of Hara et al. [10], who demonstrated the utility of ChatGPT-assisted thematic and emotional analysis in nursing education. By incorporating sentence-level semantic clustering and cross-participant emotional mapping, we were able to visualize and triangulate shared patterns of meaning. This multi-modal analysis helped reduce investigator bias and enhanced transparency in thematic interpretation, which is particularly relevant in exploratory studies with small samples [10]. Moreover, the use of AI-assisted methods such as ChatGPT may hold promise for scalable, replicable thematic analyses in nursing pedagogy, particularly where faculty resources for qualitative analysis are limited.\u003c/p\u003e\u003cp\u003eNevertheless, the study has several limitations. The emotional labeling process\u0026mdash;while supported by a refined taxonomy and human validation\u0026mdash;remains interpretive and context-dependent. Additionally, all participants in this study identified as female, which may have influenced both the emotional expressions and thematic interpretations. Gendered dimensions of empathy, communication, and ethical engagement in clinical settings warrant further investigation. Moreover, the sample was drawn from a single cohort at one institution, potentially limiting transferability. Future research should explore how repeated or longitudinal shadowing opportunities influence professional identity development, emotional resilience, and ethical reasoning in nursing students.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study found that even a single episode of operating room (OR) shadowing during undergraduate nursing education can leave a lasting impact on novice nurses\u0026rsquo; emotional engagement, ethical awareness, and professional identity. Participants internalized values such as teamwork, empathy, and patient safety, often through emotionally resonant moments.\u003c/p\u003e\u003cp\u003eThe findings support the integration of brief but meaningful shadowing experiences and guided reflection into nursing education. These approaches may effectively bridge theoretical learning with real-world practice, promoting deeper professional growth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Nagasaki Medical Center (Approval No. 2024016). This study does not involve a clinical trial; therefore, a clinical trial number is not applicable. All methods were performed in accordance with relevant guidelines and regulations. This study was conducted in accordance with the ethical standards of the Declaration of Helsinki (1964) and its amendments. All observational protocols were approved by the institutional and licensing committees of Nagasaki Medical Center. Informed consent was obtained from all participants prior to their inclusion in the study. Participants were provided with detailed explanations of the study's purpose, methods, risks, and benefits to ensure their voluntary participation. Privacy and confidentiality of the participants were strictly protected, and the recorded data and interview content were anonymized and handled with the utmost care to ensure data security.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the work of the past and present members of our medical center.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests or conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKentaro Hara conceptualized and designed the study, supervised data collection and analysis, and led the manuscript writing.\u003cbr\u003e\u0026nbsp;Reika Tachibana contributed to participant recruitment, conducted interviews, and supported data interpretation.\u003cbr\u003e\u0026nbsp;Ryosuke Kumashiro assisted in thematic coding, data organization, and provided critical revisions to the manuscript.\u003cbr\u003e\u0026nbsp;Takahiro Inoue offered methodological guidance on qualitative analysis, supervised the integration of ChatGPT-assisted procedures, and contributed to manuscript refinement.\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCochran K. Guidelines in practice: prevention of unintentionally retained surgical items. \u003cem\u003eAORN J\u003c/em\u003e. 2022;116(5):427\u0026ndash;40. https://doi.org/10.1002/aorn.13804\u003c/li\u003e\n\u003cli\u003eTotur Dikmen B, Bayraktar N. Nursing students\u0026apos; experiences related to operating room practice: a qualitative study. \u003cem\u003eJ Perianesth Nurs\u003c/em\u003e. 2021;36(1):59\u0026ndash;64. https://doi.org/10.1016/j.jopan.2020.06.025\u003c/li\u003e\n\u003cli\u003eLuckenbach A, Nelson-Brantley H, Ireland-Hoffmann G. Affiliate faculty in nursing clinical education: student and faculty perceptions. \u003cem\u003eNurse Educ\u003c/em\u003e. 2021;46(4):245\u0026ndash;9. https://doi.org/10.1097/NNE.0000000000000925\u003c/li\u003e\n\u003cli\u003eGeorge TP, Murphy PF, DeCristofaro C, Hucks JM. Student perceptions regarding collaborative intraprofessional nursing education. \u003cem\u003eNurse Educ\u003c/em\u003e. 2019;44(4):226\u0026ndash;30. https://doi.org/10.1097/NNE.0000000000000584\u003c/li\u003e\n\u003cli\u003eSarikaya O, Civaner M, Kalaca S. The anxieties of medical students related to clinical training. \u003cem\u003eInt J Clin Pract\u003c/em\u003e. 2006;60(11):1414\u0026ndash;8. https://doi.org/10.1111/j.1742-1241.2006.00869.x\u003c/li\u003e\n\u003cli\u003ePrince KJ, Boshuizen HP, van der Vleuten CP, Scherpbier AJ. Students\u0026apos; opinions about their preparation for clinical practice. \u003cem\u003eMed Educ\u003c/em\u003e. 2005;39(7):704\u0026ndash;12. https://doi.org/10.1111/j.1365-2929.2005.02207.x\u003c/li\u003e\n\u003cli\u003eRadcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. \u003cem\u003eMed Educ\u003c/em\u003e. 2003;37(1):32\u0026ndash;8. https://doi.org/10.1046/j.1365-2923.2003.01405.x\u003c/li\u003e\n\u003cli\u003eSchuler MS. Shadowing in early baccalaureate nursing education and its influence on professional role perspectives. \u003cem\u003eNurse Educ\u003c/em\u003e. 2016;41(6):304\u0026ndash;8. https://doi.org/10.1097/NNE.0000000000000276\u003c/li\u003e\n\u003cli\u003eTong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. \u003cem\u003eInt J Qual Health Care\u003c/em\u003e. 2007;19(6):349\u0026ndash;57. https://doi.org/10.1093/intqhc/mzm042\u003c/li\u003e\n\u003cli\u003eHara K, Tachibana R, Kumashiro R, Ichihara K, Uemura T, Maeda H, et al. Emotional analysis of operating room nurses in acute care hospitals in Japan: insights using ChatGPT. \u003cem\u003eBMC Nurs\u003c/em\u003e. 2025;24(1):30. https://doi.org/10.1186/s12912-024-02655-9\u003c/li\u003e\n\u003cli\u003evon der Lancken S, Gunn E. Improving role identity by shadowing interprofessional team members in a clinical setting: an innovative clinical education course. \u003cem\u003eJ Interprof Care\u003c/em\u003e. 2019;33(5):464\u0026ndash;71. https://doi.org/10.1080/13561820.2018.1538940\u003c/li\u003e\n\u003cli\u003eRotz ME, O\u0026apos;Neill DD. Exploring second professional year pharmacy student reflections after an interprofessional shadowing experience with nursing students in critical care units: a qualitative study. \u003cem\u003eJ Interprof Care\u003c/em\u003e. 2021;35(3):383\u0026ndash;90. https://doi.org/10.1080/13561820.2020.1769579\u003c/li\u003e\n\u003cli\u003eEtherington C, Burns JK, Kitto S, Brehaut JC, Britton M, Singh S, et al. Barriers and enablers to effective interprofessional teamwork in the operating room: a qualitative study using the Theoretical Domains Framework. \u003cem\u003ePLoS One\u003c/em\u003e. 2021;16(4):e0249576. https://doi.org/10.1371/journal.pone.0249576\u003c/li\u003e\n\u003cli\u003eManser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. \u003cem\u003eActa Anaesthesiol Scand\u003c/em\u003e. 2009;53(2):143\u0026ndash;51. https://doi.org/10.1111/j.1399-6576.2008.01717.x\u003c/li\u003e\n\u003cli\u003eShi R, Marin-Nevarez P, Hasty B, Roman-Micek T, Hirx S, Anderson T, et al. Operating room in situ interprofessional simulation for improving communication and teamwork. \u003cem\u003eJ Surg Res\u003c/em\u003e. 2021;260:237\u0026ndash;44. https://doi.org/10.1016/j.jss.2020.11.051\u003c/li\u003e\n\u003cli\u003eRyan GV, Callaghan S, Rafferty A, Higgins MF, Mangina E, McAuliffe F. Learning outcomes of immersive technologies in health care student education: systematic review of the literature. \u003cem\u003eJ Med Internet Res\u003c/em\u003e. 2022;24(2):e30082. https://doi.org/10.2196/30082\u003c/li\u003e\n\u003cli\u003eMathew RK, Immersive Healthcare Collaboration, Mushtaq F. Three principles for the progress of immersive technologies in healthcare training and education. \u003cem\u003eBMJ Simul Technol Enhanc Learn\u003c/em\u003e. 2021;7(5):459\u0026ndash;60. https://doi.org/10.1136/bmjstel-2021-000881\u003c/li\u003e\n\u003cli\u003eMonahan L, Sparbel K, Heinschel J, Rugen KW, Rosenberger K. Medical and pharmacy students shadowing advanced practice nurses to develop interprofessional competencies. \u003cem\u003eAppl Nurs Res\u003c/em\u003e. 2018;39:103\u0026ndash;8. https://doi.org/10.1016/j.apnr.2017.11.012\u003c/li\u003e\n\u003cli\u003evon der Lancken S, Gunn E. Improving role identity by shadowing interprofessional team members in a clinical setting: an innovative clinical education course. \u003cem\u003eJ Interprof Care\u003c/em\u003e. 2019;33(5):464\u0026ndash;71. https://doi.org/10.1080/13561820.2018.1538940\u003c/li\u003e\n\u003cli\u003ePark M, Kjervik D, Crandell J, Oermann MH. The relationship of ethics education to moral sensitivity and moral reasoning skills of nursing students. \u003cem\u003eNurs Ethics\u003c/em\u003e. 2012;19(4):568\u0026ndash;80. https://doi.org/10.1177/0969733011433922\u003c/li\u003e\n\u003cli\u003eAlmomani E, Sullivan J, Saadeh O, Mustafa E, Pattison N, Alinier G. Reflective learning conversations model for simulation debriefing: a co-design process and development innovation. \u003cem\u003eBMC Med Educ\u003c/em\u003e. 2023;23(1):837. https://doi.org/10.1186/s12909-023-04778-0\u003c/li\u003e\n\u003cli\u003eHuseb\u0026oslash; SE, Reierson I\u0026Aring;, Hansen A, Solli H. Post-simulation debriefing as a stepping stone to self-reflection and increased awareness \u0026ndash; a qualitative study. \u003cem\u003eAdv Simul (Lond)\u003c/em\u003e. 2024;9(1):33. https://doi.org/10.1186/s41077-024-00306-2\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Operating room shadowing, Novice nurses, Reflective learning, Emotional responses, Nursing education","lastPublishedDoi":"10.21203/rs.3.rs-6969322/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6969322/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOperating room (OR) shadowing allows nursing students to observe high-stakes teamwork and clinical decision-making. However, the emotional and professional impact of such experiences on novice nurses remains underexplored.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis qualitative study explored how a single episode of OR shadowing during undergraduate clinical training influenced novice nurses\u0026rsquo; emotional responses and professional development. Semi-structured interviews were conducted with six novice nurses within their first year of clinical practice. Transcripts were analyzed using a ChatGPT-assisted thematic and sentiment analysis approach. Semantic clustering and emotion-frequency visualizations were also applied to enhance interpretive transparency.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSix superordinate themes and 19 subthemes were identified: (1) Communication and Teamwork, (2) Holistic and Empathetic Care, (3) Patient Safety and Ethical Awareness, (4) Professional Identity and Role Formation, (5) Skill Development and Clinical Preparedness, and (6) Transformative and Experiential Learning. Participants expressed a range of emotions\u0026mdash;most notably respect, gratitude, admiration, and growth\u0026mdash;which were strongly associated with reflections on ethical practice, role modeling, and future aspirations. Visualization techniques revealed that emotionally resonant experiences were often thematically clustered, suggesting shared meaning structures across participants. Despite the brevity of the experience, many participants described lasting effects on their clinical attitudes, ethical awareness, and self-concept as nurses.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eA single OR shadowing experience during undergraduate education can evoke deep emotional responses and support early professional identity formation among novice nurses. The integration of structured reflection or guided debriefing may enhance these effects. Findings support the inclusion of observational experiences, even brief ones, in undergraduate nursing curricula as a means to cultivate ethical sensitivity, interprofessional awareness, and reflective practice.\u003c/p\u003e","manuscriptTitle":"Lasting Impact of Undergraduate Operating Room Shadowing on Novice Nurses: A ChatGPT-Supported Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-14 11:45:31","doi":"10.21203/rs.3.rs-6969322/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-18T18:41:18+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-18T18:35:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306781938525415914379141692279250709858","date":"2025-08-18T14:20:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"305063515866793712502726815992685637571","date":"2025-08-18T11:52:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-13T20:03:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202199884270585093706999495973750319591","date":"2025-08-12T02:09:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18187401982340673121599123904614600823","date":"2025-08-09T22:36:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90356646399356251694802340569546801483","date":"2025-08-05T15:51:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-10T01:51:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-26T06:32:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-26T04:06:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-26T04:06:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-06-25T00:10:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d65f25d6-6465-4a2a-8a9e-02e150b52ffc","owner":[],"postedDate":"July 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T15:58:38+00:00","versionOfRecord":{"articleIdentity":"rs-6969322","link":"https://doi.org/10.1186/s12912-025-03770-x","journal":{"identity":"bmc-nursing","isVorOnly":false,"title":"BMC Nursing"},"publishedOn":"2025-09-02 15:56:53","publishedOnDateReadable":"September 2nd, 2025"},"versionCreatedAt":"2025-07-14 11:45:31","video":"","vorDoi":"10.1186/s12912-025-03770-x","vorDoiUrl":"https://doi.org/10.1186/s12912-025-03770-x","workflowStages":[]},"version":"v1","identity":"rs-6969322","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6969322","identity":"rs-6969322","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}