Background: Breathing and coughing exercises are fundamental components of nursing care in the management of chronic respiratory diseases, and the way students learn these skills is closely related to their clinical skill development. Active learning approaches that combine observation and participation may support skill acquisition more effectively than passive instruction. The Fishbowl teaching method is an interactive approach that allows students to learn through structured observation, discussion, and practice. However, its use in teaching breathing and coughing exercises in nursing education has not yet been examined. This study aims to evaluate the effect of the Fishbowl teaching method on nursing students' learning experience in the instruction of breathing and coughing exercises. Methods: This study is designed as a randomized controlled pretest-posttest experimental study. A total of 63 first-year nursing students will be randomly assigned to either an intervention group or a control group. The intervention group will receive instruction using the Fishbowl teaching method, while the control group will be taught using traditional demonstration-based instruction. Data will be collected using the Knowledge Test, Academic Self-Efficacy Scale, and Instructional Materials Motivation Scale at pretest and posttest time points.
Nursing education plays a fundamental role in preparing students to transform theoretical knowledge into safe and effective clinical practice. In addition to increasing knowledge levels, it aims to develop higher-order competencies such as critical thinking, clinical decision-making, and problem-solving. However, traditional information-centered teaching approaches may be insufficient for fostering these competencies. Contemporary educational perspectives emphasize active learning processes involving observation, practice, reflection, and feedback, leading nursing education toward learner-centered and interactive methods that support deeper learning and clinical readiness. Chronic respiratory diseases remain a major public health concern due to high morbidity and mortality. Nursing care is central to their management, particularly through monitoring respiratory status, symptom control, and patient education. Among non-pharmacological interventions, breathing and coughing exercises are essential for airway clearance, ventilation improvement, treatment adherence, and prevention of complications. Therefore, nurses must be competent not only in performing these exercises but also in teaching them effectively to patients. Because correct performance directly affects clinical outcomes, these exercises require structured teaching and feedback. Conventional lecture-based instruction often leads to passive participation, whereas interactive strategies enhance engagement and knowledge transfer. One such approach is the Fishbowl method, an interactive small-group strategy in which students alternate between performer and observer roles, followed by feedback and reflection. This structure promotes active participation and clinical reasoning. Beyond cognitive and psychomotor skills, affective outcomes are also important. Academic self-efficacy-the belief in one's ability to successfully perform a task-strongly influences motivation and performance. Learning environments that include peer observation and active participation may strengthen self-efficacy perceptions. Although the Fishbowl method has been studied for various learning outcomes, its effectiveness in teaching breathing and coughing exercises has not been directly examined. Investigating its impact on nursing students' knowledge, self-efficacy, and motivation therefore represents a relevant area of inquiry.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
63
Students in the intervention group (n = 33) were divided into subgroups of 5-6 students to facilitate effective implementation of the Fishbowl method. Six separate sessions were conducted using the same scenario ensuring content standardization. Before the sessions, students received a briefing from the faculty member responsible for the Fundamentals of Nursing laboratory course. The scenario was distributed in print, roles (student nurse, patient, observer) were explained, and students were given 10-15 minutes to review the case and voluntarily select roles; the researcher acted only as a facilitator. During the session, inner-circle students performed the application while outer-circle students evaluated performance using the Fishbowl Observation Form. After each session, structured feedback was provided by the observers and faculty member, and strengths and areas for improvement were discussed. Each session lasted approximately 25-30 minutes.
Atatürk University
Erzurum, Turkey (Türkiye)
Knowledge Test
The Knowledge Test was developed by the researchers to assess students' knowledge of diaphragmatic breathing and effective coughing exercises. Test items were prepared in line with the literature by three researchers who are experts in the Fundamentals of Nursing discipline. The development of the items was informed by core Fundamentals of Nursing textbooks and up-to-date nursing education literature, resulting in a 15-item multiple-choice test with four response options for each item. The test consisted of two main content domains: diaphragmatic breathing (Items 1-8) and effective coughing exercises (Items 9-15). Each item had a single correct answer. The internal consistency reliability (Cronbach's alpha) of the Knowledge Test was 0.70 for the pretest and 0.78 for the posttest.
Time frame: 1 week
The Academic Self-Efficacy Scale (ASES)
The Academic Self-Efficacy Scale (ASES) was originally adapted into Turkish by Yılmaz et al.. The scale is unidimensional and consists of seven items assessing perceived academic self-efficacy. Responses are rated on a four-point Likert scale ranging from 1 ("Does not apply to me at all") to 4 ("Applies to me completely"), with total scores ranging from 7 to 28. Higher scores indicate higher levels of perceived academic self-efficacy. The Cronbach's alpha coefficient of the Turkish version of the scale was reported as 0.79. In the present study, Cronbach's alpha values were 0.85 for the pretest and 0.89 for the posttest.
Time frame: 1 week
The Instructional Materials Motivation Survey (IMMS)
The Instructional Materials Motivation Survey (IMMS) was developed by Keller and adapted into Turkish by Dinçer and Doğanay. The IMMS consists of 33 items across four subdimensions: attention, relevance, confidence, and satisfaction. Items are rated on a five-point Likert scale ranging from 1 ("Not true") to 5 ("Very true"), yielding total scores between 33 and 165. Higher scores indicate higher levels of motivation toward instructional materials. The Cronbach's alpha reliability coefficient of the Turkish version of the IMMS was reported as 0.96. In this study, the overall Cronbach's alpha values were 0.98 for the pretest and 0.99 for the posttest.
Time frame: 1 week
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