In this study, 60 interns were randomly selected from 163 male nursing students in a tertiary hospital in Hunan Province from July to August 2020 and were subsequently assigned to the control (n= 30) and observing (n= 30) groups, respectively, using the random number table method. The randomisation process was performed using statistical analysis system software. The random numbers and groups were sealed in opaque envelopes and kept by the director of the nursing teaching and research department, who also helped supervise the random assignment process. A single-blind method was adopted, with the individuals involved in the routine pre-employment training, career planning group counseling and the collection and analysis of the questionnaires unaware of the grouping.
The inclusion criteria for the present study included male nurses who had been completing internships in 2020 with a duration of < 1 week who were willing to participate in this study and who were currently working on the clinical front line and had no communication barriers with others. The exclusion criteria included trainees who were unable to guarantee sufficient participation time or who were unwilling to voluntarily participate in the study, as well as those with an internship duration of > 1 week.
Sample size calculation
A convenience sampling method was used to collect data for the study population. The sample size was calculated based on the Raosoft sample size calculator [http://www.raosoft.com/samplesize.html (accessed November 16, 2021)]. with an error range of 5% and a confidence level of 95% . The sample size calculated was at least 27 for each group.
Establishment of the group counseling team
The team members were nursing professional teachers who had been trained in the area of group coaching and had counseling-related qualifications. The group counseling team consists of a total of seven individuals, including one director of the nursing teaching and research department, one officer of the nursing teaching and research department and five experts operating in various nursing-related fields, including nursing teaching, specialist nursing, nursing management, nursing research and scientific research design.
The leader of the group counseling activity was the director of the nursing teaching and research department, who had a PhD qualification, was a professor of nursing and mainly engaged in nursing education and nursing management. The leader was mainly responsible for guiding the design and implementation of the group counseling programme. The group counseling activity was overseen by the officer of the nursing teaching and research department, who had a master’s degree, was a nurse practitioner and was mainly engaged in nursing education. This individual was mainly responsible for the program design and the coordination and hosting of the activity. Among the five group counseling activity instructors, one was a male clinical nursing instructor who had a master’s degree, was a vice professor of nursing, was mainly engaged in nursing teaching, and whose duties included analyzing the form and characteristics of employment and helping male nursing students gain a comprehensive understanding of themselves and improve their knowledge of the nursing profession. The second instructor was a specialized male nurse who had a bachelor’s degree, was a chief nurse mainly engaged in clinical acute and critical care nursing, and who shared his career history and career planning to help male nursing students strengthen their career goals, improve their career satisfaction and establish correct career values. The third instructor was a male nurse manager who had a master’s degree, was a vice professor of nursing and was mainly engaged in nursing management, teaching male nursing students about career planning and sharing their career planning history to help male nursing students better understand the importance of career planning and the nursing profession from multiple perspectives. The fourth instructor was a male nursing postgraduate student studying in the field of nursing education; their role was to increase the awareness among male nursing students of the importance of academic upgrading and of making multi-directional choices in their career planning. The final instructor was a male doctor of medicine research professional and a PhD supervisor who was primarily engaged in nursing teaching, as well as cultivating an interest in scientific research and promoting male nursing students’ comprehensive quality improvement.
Counseling program development
This study combined Donald E. Super’s career development theory, Krumboltz’s social learning theory and Frank Parsons’ trait and factor theory (which formed the theoretical basis of this study), and designed various group activities around the core aspects of career planning, based on group counseling formation, including career identity, career satisfaction, organizational commitment, and a willingness to remain in the workplace . The group counseling program was designed to include six modules, with each module developed around an activity theme and including four sessions, ie warm-up activities, themed activities, summaries and sharing, and homework assignments. Details of the specific implementation plan are provided in Table 1.
Implementing the counseling programme
The counseling activity was based on a variety of games, with each activity incorporating a different game to introduce the activity theme prior to forming small groups. This enabled the group members to participate in the themed activities in an open, accepting and supportive group atmosphere. After each activity, the counselor summarized the proceedings, and the group members shared their feelings about the activity. Concerning the training method, the observation group participated in a one-week pre-employment training session for clinical practice that was organized by the nursing department. The training mainly includes an introduction to the hospital, nursing etiquette norms and the core nursing system, as well as professional ethics, nursing emergency management and career prospects and planning. Following the pre-employment training, the male nursing students took turns to work in each clinical department according to the internship syllabus plan. Additionally, the observation group conducted a six-week career planning group counseling program alongside the internship. The counseling sessions were provided Fridays from 7:00 pm to 9:00 pm, once a week for a total of six training sessions.
The control group also participated in the pre-employment training on clinical internship, and participated in the internship rotation in each clinical department following the completion of the training. The internship department and internship content were the same as those used for the observation group. To prevent any mutual influence between the two groups, a different rotation order was used for each group.
General information questionnaire
This questionnaire was self-created and included age, professional volunteering, education level and home location.
Career status assessment scale
The Chinese version of the career status assessment scale was translated by Tong Tian and consists of 23 items covering four dimensions, including 8 items on career identity, 5 to career satisfaction, 9 to organizational commitment and 1 to intention to remain in the workplace . Each item was scored using a 5-point Likert scale, with each answer assigned a score of l–5 (completely disagree, relatively disagree, uncertain, relatively agree, and completely agree, respectively), while four items were reverse scored, for a total of 23–115 points. A higher score indicated a higher evaluation of occupational status. The Cronbach’s alpha coefficients of scale and dimension ranged from 0.72 to 0.86, while the retest reliability was 0.82; the apparent content validity was 0.83, and the internal consistency coefficient was 0.86 . Accordingly, the scale was deemed valid for use among nursing staff.
Career maturity inventory
The career maturity inventory was revised by Zhiyong Zhang et al.  The corresponding questionnaire comprised 34 entries (with a total of 170 points) covering 6 dimensions, ie 8 items on career goals, 6 on career confidence, 4 on career freedom, 6 on career values, 4 on reliability on friends and family and 6 related for career references. Each item was rated according to a 5-point Likert scale, with scores ranging from 1–5 corresponding to highly non-conforming, non-conforming, elemental, conforming, and highly conforming, respectively. The scale had a retest reliability of 0.771, split-half reliability of 0.896 and an internal consistency reliability coefficient of 0.869, indicating overall good validity .
The group counseling team members distributed 30 copies of the career planning status questionnaire and the career maturity questionnaire among the observation group and the control group prior to the intervention and the six-week and three-month evaluation points. Uniform guidance language was used before distributing the questionnaires; all questionnaires were distributed on the spot and were successfully collected. All of the returned questionnaires were valid. To ensure the accuracy of the data analysis, the data analysts and program operators were blind during this study.
Effect sizes, based on the pooled pre- and post-test standard deviation to obtain a more precise estimate, were calculated to assess the effectiveness of group counseling interventions. Odd ratios were converted to Cohen’s d (as described by Morris [16, 17]).
$$\beginarrayccd=\frac\overlinex _1-\overlinex _2s& s=\frac\sqrt \left(n_1-1\right)s_1^2+(n_2-1)s_2^2 n_1+n_2-2\endarray$$
In line with Cohen’s classification, effect sizes were classified into five levels: trivial (Cohen’s d ≤ 0.2), small (> 0.2), moderate (> 0.5), large (> 0.8), very large (> 1.3) .
An Excel database was created, and the SPSS Statistics 21.0 software program was used for statistical analysis of the data. In terms of the quantitative variables, a normality (sphericity) test was performed; the normally distributed data were expressed as mean ± standard deviation (x± s), while an independent samples t-test and a repeated measures analysis of variance (ANOVA) test were conducted to compare the differences between the groups (test level alpha = 0.05).