Effect of role-play technique on nursing students’ attitudes towards student-centred teaching: a Quasi-Experimental study

Abstract

Background

Role-play’- one of the teaching techniques utilised in contemporary teaching appears to be a new trend that has been developing in the field of education.

Purpose

This study aimed to determine the effect of the ‘role-play’ technique implemented on the fourth-year students attending the Faculty of Nursing at the Near East University in Northern Cyprus on their attitudes towards student-centred teaching techniques.

Methods

This study was designed as a single group quasi-experimental study with pretest and posttest. The study was conducted with the fourth-year nursing students (n = 131). The data were collected using the ‘Data Collection Form’ and ‘Scale of Attitudes Towards Using Student-Centred Teaching Methods and Techniques’. After conducting the pretest, the students were divided into twelve groups. A script was drafted for each group and the role-play was performed in front of the class. After the practices were completed, posttest was applied. All necessary permissions were obtained to conduct the study. The collected data were evaluated in the SPSS 25.0. Data were evaluated with 95% confidence interval and p = 0.05 error margin.

Results

A statistical difference was found between the pretest (96.16 ± 12.00) and posttest (99.29 ± 8.51) mean scores of the students on the ‘scale of attitudes towards using student-centred teaching methods and techniques’ (p = 0.006).

Conclusion

The integrated use of the role-play technique in the vocational course of nursing had a positive effect on students’ attitudes towards student-centred techniques. This situation contributes to the development of students’ knowledge and skills in vocational courses.

Clinical trial number

Not applicable.

Introduction

Nursing is a practice based proffesion, nurses need to improve their skills during their educational period in order to be able to deliver a high-quality healthcare service [1]. Despite having the opportunity to improve these skills in the clinical setting, practices are limited in circumstances due to overcrowded student groups and online education [1, 2]. Such circumstances require the development of efficient educational tools and strategies to attain nursing competence [3, 4]. An effective education requires promoting active learning by selecting and utilising effective methods, techniques, and strategies [5]. Educational settings where the teacher is the sole actor in the classroom and the student sits back and observes do not draw the student’s attention. It is known that permanent and effective learning and skill development are impossible in such environments [6]. In the contemporary education settings, on the other hand, all students are expected to make an effort to; learn, assume an active role in teaching, and achieve the aims of learning. In other words, today’s teaching and learning understanding has become ‘student-centred’ with the active learning method and promoting the learning process of students [5]. Students’ engagement, success, satisfaction, creativity, self-esteem, and professional skills are improved, while absenteeism, negative behaviours, and school dropouts reduce with ‘student-centred’ trainings [7].

‘Role-play’— one of the teaching techniques utilised in contemporary teaching appears to be a new trend that has been developing in the field of education. Role-play aims to improve student performance by employing it in learning settings and offers innovative solutions to raise student performance. Role-play is an important force in motivating students and raising commitment to the classroom setting, as well as providing students with the opportunity to receive instant feedback about classroom processes. It also gives students the opportunity to monitor and evaluate their achievements in the learning process. In this case, role-play appears as an alternative to the basic motivational educational technique [8].

Role-play is an experiential approach that provides health students with a safe and realistic learning setting that integrates content, emotion and experience. The use of role-play as scripted learning is designed to provide students the opportunity to engage in career-related activities through roleplay. Its integration into nursing education helps to achieve a permanent learning level by providing active participation of nursing students in teaching and improving the effect of education. A study conducted with nursing students in Taiwan reported that role-play practice had an effect on empathy, caring behaviour, and competence [9]. Drama-supported role-play practice in Turkey resulted in an improvement in the empathy and self-sacrifice levels of nursing students [10]. A study conducted with nursing students in China revealed that the role-play technique implemented under the course reduced stigmatisation and negative attitudes towards people with mental illness [11]. This study aimed to determine the effect of the implemented ‘role-play’ technique implemented on the attitude of nursing fourth-year nursing students at Near East University in Northern Cyprus toward student-centred teaching methods and techniques.

Hypothesis of the study

H0

The ‘role-play’ technique applied to nursing students in vocational courses does not significantly effect on their mean scores on the ‘scale of attitudes towards using student-centred teaching methods and techniques’.

Methods

Study design

This study was designed as a single group quasi-experimental trial with pretest and posttest.

Population and sample

The population consisted of the fourth-year nursing students (N = 152) attending the Faculty of Nursing at Near East University. The sample size was determined as 122 participants in total with a power of 95%, a margin of error of 5%, and a medium effect (0.3) accorging to power analysis using the G*Power software. Since it was estimated that there will be dropouts in the sample, it was aimed at reaching the whole population, and the study was completed with n = 131 participants.

Measurements

The data were collected using the ‘Data Collection Form’ developed by the researchers upon literature review and ‘Scale of Attitudes Towards Using Student-Centred Teaching Methods and Techniques’.

• The ‘Data Collection Form’ was prepared by the researchers upon literature review. This form includes five questions about the participants’ descriptive characteristics (age, gender, status of taking charge of ‘role-play’ practice, etc.).

• Koç C. conducted the validity and reliability study of the ‘scale of attitudes towards using student-centred teaching methods and techniques’ in 2014. The content validity of the scale was evaluated with the opinions of experts in the field; exploratory and confirmatory factor analysis was performed for structural validity. The factor loadings of the items ranged from.60 to.83. In this study, the scale was used directly and no item changes were made. The scale is a five-point Likert type (1: strongly disagree, 2: disagree, 3: undecided, 4: agree, 5: strongly agree), and consists of 27 items and 4 subscales (valuing (10 items), resisting (7 items), positive effects (6 items), and cost belief (4 items)). The minimum and maximum scores of the scale are 27 and 135, respectively. On the scale, the ‘resisting’ and ‘cost belief’ subscales are scored inversely. The Cronbach’s alpha coefficient of the scale was found to be 0.93 [12]. In this study, the Cronbach’s alpha value of the scale was determined to be 0.86.

Data collection

The study was conducted at the Faculty of Nursing, Near East University in Northern Cyprus. The Faculty of Nursing was established in 2018 and offers four-year undergraduate nursing education in Turkish and English. In the faculty, there are 763 Turkish students and 512 English students from African countries. This study was conducted between 12 April and 27 May 2022, the ‘data collection form’ and the ‘scale of attitudes towards using student-centred teaching methods and techniques’ were employed as pretests for the fourth-year students who were undergraduate nursing students taking a vocational nursing course. After the pretest procedure, the lecturer divided the students into twelve groups for the twelve topics that were implemented under the ‘Public Health Nursing’ course after the lecturer theoretically taught the topic to the students (10–12 participants). For each group, one topic was implemented. Scripts that covered the determined topics were drafted with support from the lecturer. An expert in the field of public health nursing gave support for the content analysis of the scripts. After rehearsals and preparations, the students performed a 40–to 60-minute show with the ‘role-play’ technique in the classroom setting, following the performances, the assigned topic was discussed in the classroom setting. Each week, students demonstrated the role-play technique for one topic, and the application was completed in twelve weeks. Then, the posttest procedure of the ‘scale of attitudes towards using student-centred teaching methods and techniques’ was readministered.

The scripts for the role-play practice included ‘getting to know the community, home visits, women’s health, child health, adolescent health, men’s health, elderly health, approaches to disadvantaged groups, occupational health, school health, environmental health, and health services in disasters’. Figure. 1 shows the CONSORT diagram of the study.

Fig. 1.

The CONSORT flowchart

Inclusion criteria

• Students who enrolled for a bachelor’s degree programme in Turkish at the Faculty of Nursing.

• Fourth-year students in the Faculty of Nursing.

Variables of the study

The dependent variable of the study was the mean score of the “scale of attitudes towards using student-centred teaching methods and techniques”; whereas, its independent variables were the descriptive characteristics of the participants.

Data analysis

The Statistical Package for Social Science (SPSS) 25.0 software was used to analyse the data statistically. The Cronbach’s α value was calculated to determine the internal reliability of the scale. Frequency and percentage were used for descriptive statistics, Kolmogorov Smirnov Test was conducted to determine whether the dependent and independent variables were normally distributed. Paired samples t-test was used to compare the means for the scales, a p-value of 0.050 was considered to represent statistical significance.

Ethical consideration

Necessary written permission was obtained from Koç to use the “scale of attitudes towards using student-centred teaching methods and techniques”. In order to apply the data collection forms, necessary “Ethics Committee Approval” (NEU/2022/101–1524) was obtained from Faculty of Nursing and Ethics Committee of Near East University. Written consent was obtained from the participants.

Results

It was determined that 59.5% of the students were female and 67.2% did not apply or engage in the ‘role-play’ technique in any course before; see Table 1.

Table 1.

Descriptive characteristics of the participants (n = 131)

Variables		n	%
Gender	Female	78	59.5
	Male	53	40.5
Applying the role-play technique before	Yes	43	32.8
	No	88	67.2
Age	Min	Max	(Mean ± Sd)
	21	32	22.86 ± 1.87

In this study, the Cronbach’s alpha value of the ‘scale of attitudes towards using student-centred teaching methods and techniques’ was determined to be 0.86, as shown in Table 2.

Table 2.

Cronbach’s alpha values of the scale of attitudes towards using Student-Centred teaching methods and techniques and its subscales

The Scale and its subscales	Cronbach’s Alpha Value	Cronbach’s Alpha Value in this study
Valuing	0.94	0.92
Resisting	0.89	0.79
Trusting in Positive Effects	0.90	0.94
Cost Belief	0.84	0.71
Overall Scale	0.93	0.86

A statistical difference was found between the mean scores of the students on the pretest (96.16 ± 12.00) and posttest (99.29 ± 8.51) of the ‘scale of attitudes towards using student-centred teaching methods and techniques’ (p = 0.006). Furthermore, a statistical difference was found between the pretest and posttest mean scores of students on the subscales of valuing, resisting, and positive effects (p < 0.05). See Table 3 for details.

Table 3.

Distribution of the participants’ scores on the scale of attitudes towards using Student-Centred teaching methods and techniques and its subscales

		Mean ± Sd	T	p	Cohen d
Valuing	Pretest	38.80 ± 6.61	-5.949	0.000	0.57
	Posttest	42.19 ± 5.05
Resisting	Pretest	18.49 ± 5.86	4.171	0.000	0.30
	Posttest	20.09 ± 5.11
Positive Effects	Pretest	24.33 ± 4.10	-4.690	0.000	0.50
	Posttest	26.03 ± 2.67
Cost Belief	Pretest	12.91 ± 3.25	1.134	0.259	-
	Posttest	12.56 ± 3.72
Total	Pretest	96.16 ± 12.00	-2.790	0.006	0.30
	Posttest	99.29 ± 8.51

Graph 1. shows the trends of the variables over time.

Graphic 1.

Trend graph of variables

Discussion

The COVID-19 pandemic period has negatively impacted nursing education, students had to attend online classes and were unable to develop their application skills. This limited the student’s active participation in the class. However, this has created new opportunities and practices for nursing education [13]. This century has revealed the need for educational strategies in which nursing students of the younger generation can take an interesting, innovative, and active role [14]. Over the last few years, the use of student-centred teaching methods and techniques alongside the conventional education model has been on the rise in the field of nursing. Student-centred teaching techniques contribute to the development of critical thinking and practical skills, and collaboration among students by promoting learning [15, 16]. In this case, role-play practices contribute to the development of skills by ensuring the active participation of students in situations that limit their practice, such as Covid-19. In this study, more than half of our students had not applied the role-play technique in any course before. The pretest and posttest mean scores of the ‘scale of attitudes towards using student-centred teaching methods and techniques’ were at a moderate level. This result suggests that this was due to the online nature of education during the COVID-19 pandemic and the lack of any student-centred teaching techniques in the classroom setting in previous nursing courses, despite the majority of the students being in their final year of education.

In the literature review, role-play applications applied to nursing students were reported. A quasi-experimental study conducted by Pourghaz et al. revealed that the satisfaction level of nursing students with the role-play method practised in the course was higher than other educational methods (e-learning and lecture) [17]. A quasi-experimental study conducted by Jasemi et al., reported that the role-play method implemented on nursing ethical codes created a statistical difference between the groups (lecture and control group) [15]. A study by Delnavaz et al. indicated that the role-play method implemented in scenario-based triage training was effective in improving nursing students’ knowledge and practices [18]. In this study it was determined that the scenario-based role-play method implemented on the students had a positive effect on their attitudes towards using student-centred teaching methods and techniques. The results of this study are compatible with the literature. The improvement in students’ attitudes towards student-centred teaching methods may be due to the ability of students to assume an active role in the courses by employing the role-play method in the classes.

The related studies have showed that student-centred education raises students’ motivation to learn, improves the level of information recall, and adds depth of understanding [19]. In their study, Manzoor et al. found that medical students considered role-play to be the most effective educational method. 78.5% of these students stated that role-play could increase their knowledge about the topic, and 88.9% stated that it would improve their communication skills [20]. In their study, Topbaş & Toy, found that student-centred education positively affected the professional development of students in terms of teaching skills and they gained effective skills [21]. This study showed an increase in the posttest mean scores of the subscales of “valuing”, “positive effects,” and “resisting” of the scale of attitudes towards using student-centred teaching methods and techniques compared to their pretest mean scores, and a statistically significant difference was found. The senario-based role-play practice and discussion platform after the lecture in this study provided students the opportunity to demonstrate their individual traits. This resulted in positive effects, because each student demonstrate his or her own presence in the course, putting forward his or her knowledge, feeling that he or she was valuable, and breaking down his or her prejudices against using educational techniques that he or she had not previously used.

Conclusion and recommendations

The fact that nursing is a professional, popular and one of the most prefered proffessional couse, is among the reasons for preference. Therefore, the overcrowded student groups have brought along the use of different and various teaching techniques. The integrated use of the role-play technique in the vocational course of nursing had a positive effect on students’ attitudes towards student-centred techniques (Cohen’s d: 0,30 − 0,57). Based on the findings of this research,

• It is recommended that the role-play technique should be used in vocational courses,

• Similar studies should be conducted in different groups,

• Randomised controlled experimental trials with role-play interventions should be conducted.

Limitations

There are some limitations to this study; the study was not designed as a randomised controlled experimental trial since interactions could not be prevented, and it was conducted as a single group pretest and posttest design.

Author contributions

All authors have agreed with the content of the manuscript and contributed to the work as follows: D.N.: conceptualization; data collection; methodology; statistical analysis; drafting the initial manuscript and revising/editing the final version N.A.: conceptualization; data collection; methodology; drafting the initial manuscript and revising/editing the final version.

Funding

The authors reported that there is no funding associated with the work featured in this article.

Data availability

The datasets will be made available to appropriate academic parties on request from the corresponding author.

Declarations

Ethics approval and consent to participate

Necessary written permission was obtained from Koç to use the “scale of attitudes towards using student-centred teaching methods and techniques”. In order to apply the data collection forms, necessary “Ethics Committee Approval” (NEU/2022/101–1524) was obtained from Faculty of Nursing and Ethics Committee of Near East University. All methods were carried out in accordance with the declaration of Helsinki. Written informed consent was obtained from all the participants prior to enrolment in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.