This study will look at whether a teaching method called "Sequential Case Triangle-Based Project-Based Learning" helps nursing students learn psychosocial care skills better. The study will take place during a Psychosocial Nursing course for fourth-year nursing students. Students will be divided into groups. Each group will work on one part of a patient case (creating the case, assessing it, or planning nursing care) using short role-play videos, building on the work of the group before them. Before and after the course, students will complete surveys measuring their psychosocial care competency, teamwork (cooperative learning) skills, and clinical reasoning skills. The study will compare students' scores before and after the course to see if this teaching method improved these skills.
Background: Nursing education aims to develop critical thinking, problem-solving, and clinical reasoning skills, alongside the ability to provide holistic psychosocial care. Case-based and project-based learning are student-centered strategies shown to support these outcomes, but their combined application in a sequential, team-dependent format has not been widely studied in psychosocial nursing education. Objective: To evaluate the effect of a Sequential Case Triangle-based project-based learning approach, applied within a Psychosocial Nursing course, on nursing students' self-assessed psychosocial care competency, cooperative learning, and clinical reasoning levels. Hypotheses: H1: Students' psychosocial care competency self-assessment scores will increase after the intervention. H2: Students' cooperative learning scores will increase after the intervention. H3: Students' clinical reasoning levels will increase after the intervention. Design: Single-group, pretest-posttest quasi-experimental design. Setting: Fourth-year nursing students enrolled in the "Psychosocial Nursing" elective course (Turkish-medium and English-medium sections) at Istanbul Medipol University, Faculty of Health Sciences, Department of Nursing, during the 2025-2026 spring semester. Intervention: Over the 15-week course, the class was divided into 20 main groups of 9 to 12 students each (179 participants in total), and every main group was split into three subgroups responsible for a sequential stage of the nursing process: case creation (depicting psychosocial responses to illness), psychosocial assessment, and planning/implementing psychosocial nursing interventions. Each subgroup prepared a short role-play video for its stage and submitted it to the course instructor, who forwarded it unedited to the next subgroup. Subgroups had no access to or prior knowledge of the case content created by the preceding subgroup; each stage was developed solely on the basis of the video received, without the ability to view or revise earlier work. In the final stage, the three videos were combined into one case narrative and discussed in class. Outcomes were assessed using validated self-report instruments, administered face-to-face at baseline (course week 1) and post-intervention (course week 15). Statistical Analysis: Data were analyzed using SPSS 22.0. Descriptive statistics (mean, SD, median, min-max for quantitative variables; frequency and percentage for categorical variables) were reported. Pretest-posttest comparisons used the paired-samples t-test; group comparisons used the Student's t-test (two groups) or one-way ANOVA with Bonferroni post-hoc test (three or more groups); associations between variables were assessed with Pearson correlation. Significance was set at p\<0.05, 95% confidence interval.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
179
Intervention: Over the 15-week course, the class was divided into 20 main groups of 9 to 12 students each and every main group was split into three subgroups responsible for a sequential stage of the nursing process: case creation (depicting psychosocial responses to illness), psychosocial assessment, and planning/implementing psychosocial nursing interventions. Each subgroup prepared a short role-play video for its stage and submitted it to the course instructor, who forwarded it unedited to the next subgroup. Subgroups had no access to or prior knowledge of the case content created by the preceding subgroup; each stage was developed solely on the basis of the video received, without the ability to view or revise earlier work. In the final stage, the three videos were combined into one case narrative and discussed in class.
Istanbul Medipol University
Istanbul, Kavacık, Turkey (Türkiye)
Psychosocial Care Competency Self-Assessment
The Psychosocial Care Competency Self-Assessment Scale is an 18-item, 5-point Likert-type self-report scale with four subscales (symptom identification, use of knowledge, intervention, and diagnosis). Total scores range from 18 (minimum) to 90 (maximum), with higher scores indicating better self-assessed psychosocial care competency.
Time frame: Baseline (course week 1) and post-intervention (course week 15)
Clinical Reasoning
The Clinical Reasoning Scale for Nursing Students is a 16-item, 5-point Likert-type self-report scale with four subscales (awareness of clinical clues, verification of clinical problems, action determination and implementation, and evaluation and reflection). Total scores range from 16 (minimum) to 80 (maximum), with higher scores indicating a higher level of clinical reasoning.
Time frame: Baseline (course week 1) and post-intervention (course week 15)
Cooperative Learning
The Cooperative Learning Scale is a 15-item, 5-point Likert-type self-report scale with five factors (interpersonal skills, group processing, positive interdependence, supportive interaction, and individual accountability), with no reverse-scored items. Total scores range from 15 (minimum) to 75 (maximum), with higher scores indicating higher cooperative learning skills.
Time frame: Baseline (course week 1) and post-intervention (course week 15)
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