The effect of learning by teaching in nursing skills education on the learner’s knowledge and skill levels: a quasi-experimental study

Data was collected using a socio-demographic information form, a knowledge questionnaire, and a skills checklist for Objective Structured Clinical Examination (OSCE).

Descriptive information form.

This form, developed by the researchers, consisted of questions about students’ sociodemographic information.

The quesionnaires.

The questionnaires were developed by the researchers following a literature review [12,13,14,15] to determine the theoretical knowledge levels of the students in the study. Each of them included 10 open-ended questions about intravenous drug administration by applying an intravenous catheter and intramuscular and subcutaneous drug administration. To evaluate the validity of the questions, they were reviewed by five academicians, all of whom were experts in nursing education. Among them, two were full professors and three held doctoral degrees in nursing education. These experts were independent of the research team and contributed as external reviewers to ensure objectivity. Additionally, a pilot application was conducted on 10 third-year students of the same faculty to test the comprehensibility of the questions. After this process, some revisions were made and the questionnaires were finalized. Each questionnaire was evaluated out of 100 points (Supplemantary 1).

Skills checklists.

Skills checklists are tools that are used to evaluate students by scoring each step of the skills in question for use in OSCE assessments. In the literature, OSCEs have been reported to be reliable tools for measuring knowledge, attitudes, and skills [16]. In the research, three separate checklists were prepared for the three skills selected as the subject of skills training in line with the literature [15, 17]. The checklists created were submitted to five academicians who were experts in nursing education (two professors and three PhD holders). To test the usefulness of the checklists, a pilot application was carried out on 10 third-year students of the same faculty. After this process, some revisions were made and the final version was obtained. The checklist for each skill was evaluated out of 100 points (Supplemantary 2).

Table of Contents

Procedure

This study was conducted using the learning-by-teaching method according to the following steps (Fig. 1).

Stage 1: Training on the purpose and process of the research.

Before the study was initiated, the researchers gave information to the students in the classroom environment about the method of learning by teaching through the lecture method, videos, and visuals. The purpose and content of the method were explained to the students. Students’ questions were answered.

Stage 2: Formation of groups, application of the information form, questionnaires, and the OSCE as a pre-training assessment.

The students participating in the research were first divided into three groups using the random sampling method. The three determined training topics were distributed to the groups by drawing lots. First, the information form and the questionnaires about the teaching subjects were applied to each group (pre-training). Similarly, each group was evaluated with the OSCE prepared for the subject they taught (pre-training). Separate stations were created for the skills to be evaluated in the OSCE. For each skill, students were taken into the application room one by one and asked to practice the skill within a specified time. The skills applied at each station were evaluated with checklists. After the information form and pre-training assessments were completed, a timeline of the application was created with the students.

Stage 3: Education through Learning by Teaching (Fig. 2).

Formation of sub-study groups and preparation; student groups of 14–15 were randomly assigned to three training groups. These study groups did a detailed literature review and research on the study topics. Students discussed what they learned in the group and as a result of the discussion, they decided what, how much, and how to teach, which evaluation methods to use, and how to manage time. In line with the information they received during the theoretical hours of this course, students created an education plan that included teaching objectives, teaching methods and techniques, and teaching tools and equipment on the subject. They prepared the training content by reviewing the literature and synthesizing the information in the literature in line with the determined training plan. They shared the topics within the group according to the training content.

The students who made preparations for the subjects prepared written materials containing theoretical knowledge of the group subjects and teaching aids such as posters and PowerPoints. They themselves decided on the methods and equipment they would use. For skills teaching, they made the necessary preparations according to the materials and models they prepared and the teaching methods they determined (video teaching of skills, demonstration, etc.).

During this process, the researchers provided guidance on how students could access information sources and made necessary suggestions regarding teaching methods and activities. They also helped obtain the necessary materials.

Implementation of the teaching; students taught skills using the teaching methods, techniques, and tools they prepared in line with the education plans they made.

Stage 4: Application of questionnaires and the OSCE as a post-training assessment.

A post-training assessment was conducted after the students completed all stages of the teaching-learning method. The post-training assessments was administered to the students 3 weeks later. The questionnaires prepared for the subjects they learned by teaching were re-applied (post-training) and the OSCE was conducted to evaluate the skills they had learned by teaching (post-training).

Ethical considerations

This study was approved by the Adnan Menderes University Nursing Faculty Non-Interventional Ethics Committee (Protocol Number: E-76261397-050.99-257169, dated October 17, 2022). All procedures were conducted in accordance with the principles of the Declaration of Helsinki.

Informed consent

was obtained from all participants after they were fully briefed on the study’s purpose, methods, and their rights. Given the non-invasive and non-interventional nature of the study, verbal consent was obtained, a procedure approved by the Ethics Committee. The confidentiality and anonymity of all participants were strictly protected throughout the research process.

Data analysis

Lists of the statistical methods used, what is crucial, and the software used, appropriate to the study developed.

The statistical package for the social sciences version 25.0 (SPSS Inc, IL, USA) Software was utilized to analyze the data. Data were expressed as numbers, percentages, and mean ± standard deviation values. The dependent groups t-test was employed to make intra-group comparisons of mean pretest-posttest scores, and the paired samples t-test was used to make inter-group comparisons of mean scores. In addition to p-values, effect sizes (Cohen’s d) were calculated to evaluate the magnitude of differences. Differences were considered statistically significant at p < 0.05 unless otherwise stated.

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