The effect of collaborative learning approach on nursing students’ knowledge and skill learning for enteral nutrition: a randomized controlled study

Abstract

Background

Collaborative learning is one of the important interactive teaching methods in teaching nursing practices. This study aimed to examine the impact of the collaborative learning approach on nursing students’ knowledge levels and self-directed learning skills related to enteral nutrition.

Method

This research employed an open-label, randomized controlled design with pre-test and post-test measurements. The study sample comprised 90 first-year nursing students who were randomly assigned to the experimental (n = 45) and control (n = 45) groups. In the study, data were collected using the ‘Descriptive Characteristics Form for the Student Group,’ ‘Knowledge Test on Enteral Nutrition,’ and ‘Self-Directed Learning Skills Scale.’ Students worked in five separate groups on topics related to enteral nutrition, and afterward, group representatives shared information with all groups. The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835.

Results

It was determined that the final test and follow-up test knowledge scores of the experimental group were statistically significantly higher than those of the control group (p = 0.007; p < 0.001). Additionally, a statistically significant difference was found in all measurements of the final test scores of the experimental group’s self-directed learning skills scale (p < 0.001). When the subscales of the self-directed learning skills scale were analyzed, statistically significant differences and a strong effect were found between the pre-test and final test scores of the experimental group in self- monitoring (p < 0.001; d = 4.502), motivation (p < 0.001; d = 5.398), self-control (p < 0.001; d = 3.700), and confidence (p < 0.001; d = 6.034).

Conclusion

The fact that the student’s self-directed learning skills scale sub-dimensions (self- monitoring, motivation, self-control and confidence) are significantly higher shows that instructors should integrate the collaborative learning method into the education system to learn the right knowledge and skills. The use of collaborative learning methods is recommended for all newly acquired skills in nursing education, as is the case with enteral nutrition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08687-w.

Introduction

In the first year of undergraduate education, where health care services are provided in the widest dimension, students encounter a curriculum aimed at gaining basic knowledge and skills [1–4]. In this curriculum, there are many important topics for protecting the health of the patient and maintaining the basic needs of the patient [5, 6]. One of these topics is nutritional needs and enteral nutrition, which is important in healthcare areas [7]. Enteral nutrition, which refers to the continuous, intermittent, or bolus administration of nutrients to patients who cannot meet their nutritional needs orally through nasogastric, gastrostomy, or jejunostomy, becomes a health threat if it is not given under appropriate conditions [8]. After deciding to apply enteral nutrition to the patient, calculating the patient’s calorie requirement, confirming that the feeding tube is in the right place, care of the feeding tube, giving the appropriate position to prevent aspiration, evaluating bowel sounds and gastric residual volume, monitoring the patient in terms of diarrhea, abdominal distension, nausea, and vomiting are among the responsibilities of the nurse [8, 9]. At this point, it is of great importance for students, who are the nurses of the future, to develop evidence-based knowledge and skills. In the development of knowledge and skills, it is seen that interactive methods are adopted by moving away from traditional education today. Among these methods, the collaborative learning method takes its place.

The collaborative learning method is structured around students’ communication and interaction with each other [2]. Collaborative learning is related to many learning theories such as Social Constructivism, Piaget’s Cognitive Development Theory, and Bandura’s Social Learning Theory. It is a method built on elements such as individual responsibility, face-to-face interaction, and social skill acquisition [2]. Compared to traditional education, the benefits of collaborative learning include increased academic achievement, critical thinking, verbal communication, taking responsibility for learning, increased assessment skills, and openness to feedback [10]. In collaborative learning, the basic principle is that students form groups around the core knowledge and skills to be learned; each group shares its knowledge internally and then interacts with other groups. With this method, students can take responsibility for their own learning and develop information sharing, collaboration, and leadership skills within the group. Therefore, collaborative learning is an effective teaching method that strengthens self-directed learning and supports effective communication among team members [11].

As in other areas of health education, skills encountered for the first time in nursing education can create learning difficulties for students [2]. Nasogastric tube placement can be a source of stress for nursing students. When enteral feeding begins, even if they can perform the procedure correctly, many students may feel the need to consult someone [10]. Therefore, interaction among students is very important so that they can comfortably handle situations they encounter outside of oral feeding. In this case, collaborative learning offers students great opportunities [11]. Students can carry out the steps of the process by brainstorming and supporting each other in group work. Seeing that they can perform the steps that require attention in enteral feeding increases their motivation and self-confidence [12]. This result also brings with it the acquisition of self-management skills. There is a direct relationship between collaborative learning and self-directed learning skills. While students work in groups, it is important that they perform skills they cannot do individually together, learn by asking each other what they do not know, and see that they can perform the application. Therefore, the student’s self-confidence and motivation increase. The student can observe themselves while working with their peers [11, 12]. In a study in which collaborative learning was used with nursing students, it was observed that higher achievement, more positive relationships between students, and more psychological adjustment developed compared to traditional education methods [12]. In studies investigating the use of active learning strategies in nursing education internationally, it has been concluded that collaborative learning is of great importance in critical thinking ability, clinical performance, knowledge competence, and transformation of nursing knowledge into clinical skills [6, 11, 13, 14]. Similarly, it was emphasized that collaborative learning is an effective teaching method to increase the retention of knowledge in the development of nursing students’ knowledge and psychomotor skill levels related to local drug applications [15].

In this study, we focused on the development of students’ knowledge and self-directed learning skills related to enteral nutrition using the collaborative learning method. This research aims to contribute to the limited number of studies that simultaneously address these two structures by evaluating the effect of the collaborative learning method on students’ self-directed learning skills and, in this context, to provide a unique perspective to the literature. This study, which empirically examines the relationship between the collaborative learning approach and self-directed learning skills, is unique in that it evaluates these two important variables, which are rarely addressed together in the existing literature, within a holistic framework. It is believed that the use of the collaborative learning and self-directed learning skills scale for enteral nutrition will also guide studies on different topics.

Materials and methods

This study is a randomized controlled trial that includes pre- and post-tests. The study is aimed to evaluate the effect of the collaborative learning approach on nursing students’ knowledge and skill learning about enteral nutrition.

The purpose and hypotheses of the study

This study was conducted to evaluate the effect of the collaborative learning approach on nursing students’ knowledge and self-directed learning skills regarding enteral nutrition. The research hypotheses are as follows: “H_1-1: The collaborative learning method increases nursing students’ knowledge level regarding enteral nutrition.” “H_1-2: The collaborative learning method increases nursing students’ self-directed learning skills regarding enteral nutrition.”

Population and sample of the study

The study population comprised 116 students enrolled in the Fundamentals of Nursing Course II during the spring term of the 2023–2024 academic year in the nursing department of a university’s Faculty of Health Sciences. All students were informed about the research prior to sample selection. The sample consisted of 90 students who volunteered to participate in the teaching method used in the research and who took the pre-test (45 students in the experimental group and 45 students in the control group) (Fig. 1).

Fig. 1.

CONSORT diagram of this study

The inclusion criteria were taking the Fundamentals of Nursing Course for the first time and not having received any training on enteral nutrition before. The exclusion criteria were established as absence from classes and failure to participate in the final test.

A total of 90 students who agreed to participate in the study and completed the “Student Group Characteristics Form,” “Enteral Nutrition Knowledge Test,” and “Self-Directed Learning Skills Scale” were included in the research. Participants were assigned to the experimental and control groups by the researcher using an online randomization software (https://www.randomizer.org/). Since the study was conducted with two independent groups, a power analysis was performed using the G*Power 3.19.2 program to determine the sample size. When the effect size was set at 0.78, power at 95%, and significance level at 0.05, the minimum sample size required for each group was determined to be 44 (the sample calculation was based on study number 15). Although the total sample size calculated for the groups was 88, two volunteer students who wanted to participate in the study were not excluded from the research and were included in the sample. Accordingly, the study was completed with a total of 90 participants, 45 in the experimental group and 45 in the control group. The study was registered in the ClinicalTrials.gov system on the date the students began the study and was assigned the registration number NCT06412835. The study’s ClinicalTrials registration date is May 2024, and the study’s start date is May 8, 2024.

Data collection tools

In the study, data were collected using the ‘Descriptive Characteristics Form for the Student Group,’ ‘Knowledge Test on Enteral Nutrition,’ and ‘Self-Directed Learning Skills Scale.’

Descriptive characteristics form for the student group

Within the scope of the relevant form, the questions of age, gender, whether the students chose the nursing department voluntarily or not, and whether they had received training on collaborative learning before or not were included [16, 17] (Additional file 1).

Knowledge test on enteral nutrition

The relevant test was prepared by the researchers by reviewing the literature [2, 5, 7]. The test included multiple choice test format 20 questions about indications for enteral nutrition, nursing care of the patient receiving enteral nutrition, and points to be considered during enteral nutrition. To ensure the validity and reliability of the test, the opinions of three academics specializing in nursing fundamentals (expertise in basic skill acquisition) were sought. It was determined that the experts’ evaluations were largely appropriate and that their opinions regarding the form were statistically consistent (Kendall’s W = 0,336; p = 0,460). To strengthen the validity and reliability of the test, Cronbach’s alpha coefficient was also calculated. The test’s Cronbach’s alpha coefficient was calculated as 0.756. The related test was finalized according to the opinions of the experts (Additional file 2). The test was graded out of 100. Each correct answer was worth 5 points, and the student’s score was calculated by multiplying the number of correct questions by 5. The score obtained in the achievement test indicates the extent to which the student has acquired the knowledge measured in the test. Since this study aimed to increase knowledge about enteral nutrition, students scoring at least 50 points or above were considered normal, and those scoring 70 points or above were considered successful.

Self-directed learning skills scale

The scale used to assess self-directed learning skills was developed by Aşkın Tekkol and Demirel in 2018 on a sample of 2,600 students. The validity analyses of this five-point Likert-type measurement tool revealed that the fit indices fell within an acceptable and good fit range. The scale structure, consisting of four sub-dimensions (self-monitoring, motivation, self-control, and confidence) and a total of 21 items, was found to be valid as a model. The lowest possible score on the scale is 21, and the highest possible score is 105. A high total score indicates that individuals have high self-directed learning skills, while a low score indicates that these skills are inadequate. In the study in which the scale was developed, the Cronbach’s alpha internal consistency coefficient was reported as 0.895 [18]. In this study, the internal consistency of the scale was evaluated using Cronbach’s alpha coefficient and calculated as 0.991.

Research implementation

This study was conducted in the spring semester of the 2023–2024 academic year between 15 May and 28 June 2024. The students participating in the study were first asked to fill out the ‘Descriptive Characteristics Form for the Student Group,’ ‘Knowledge Test on Enteral Nutrition’ (pre-test), and ‘Self-Directed Learning Skills Scale’ forms. The forms were filled out at separate times to prevent interaction between the groups. Learning objectives related to enteral nutrition were determined according to Bloom’s taxonomy. The study applied the Jigsaw technique as a collaborative learning method. Considering the stages of the Jigsaw technique, in the first stage, students participating in the research were randomly divided into groups, and a group spokesperson was randomly selected from each group. In the second stage, students worked in small groups. In the third stage, information sharing was carried out both within the groups and between groups by the group spokespersons. Students were encouraged to work interactively within their groups and to interact with other groups. Within each group, each member both carried out the steps of the process and monitored the work done. In addition, self-directed learning skills were assessed using a scale. The applications carried out with the experimental and control group students in the implementation of the research are detailed below.

With the experimental group of students, a three-session application was planned. After the pre-test was administered, the theoretical lectures were given as three separate lectures within the scope of 45-minute lecture periods in the classroom environment (15 May 2024). At the end of the theoretical lectures, in the first session, the students were randomly divided into five groups of nine students each, each of whom was given a lecture on basic knowledge and skills related to enteral nutrition. Subject headings of the groups: first group; insertion and correct fixation of a nasogastric catheter, second group; points to be considered before enteral nutrition, third group; administration of enteral nutrition, fourth group; points to be considered after administration of enteral nutrition, fifth group; storage conditions of enteral nutrition. In this session, each group member was asked to make preparations within the subject headings. The groups worked on four separate days. The group spokesperson explained the activity to be carried out within the group, and the team made preparations. The team members shared the steps to be taken for the activity, and each student carried out one step. The group members supported and supervised the students as they carried out the activity. In this way, the groups carried out each activity one after the other in a cycle. In the second session, a working environment was carried out in which the students explained the topics and demonstrated skills to each other in their groups. This session was conducted in laboratory conditions, lasting a total of 14 h over four consecutive days (first, second, and third days: 4 h; fourth day: 2 h), with each class lasting 45 min. During the applications, it was observed that the students used educational methods such as role play, demonstration with models suitable for nutrition applications, lecture, and question-answer. It was observed by the researchers that each group member was active and involved in the learning process. During this session, researchers also observed the students’ level of completion of the enteral feeding procedures and the skills they developed while performing them. These observations were guided by the College of Nursing’s basic enteral feeding video (https://ecu.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=fefeaf8f-b7a6-4a26-b4b6-ae6a01573315). Students were observed to demonstrate a significant degree of correct skills through interaction. In the third session, one student from each group was voluntarily selected to carry out the interactions of the groups with each other and transferred the knowledge and skill points covered in their group to the other groups (16–31 May 2024). At the end of the application, the students were asked to complete the ‘Knowledge Test for Enteral Nutrition’ as a post-test (31 May 2024). To measure the retention of the knowledge level, the same test was applied again 4 weeks after the post-test (28 June 2024).

With the control group of students, standard course procedures were followed. After the pre-test, students received 4 h of theory, 2 h of skill demonstration, and 16 h of hands-on laboratory training on nutritional needs related to enteral nutrition. The control group also spent 14 h practicing skills in the laboratory. However, unlike the experimental group, this was done through individual practice rather than collaborative learning. The control group received theoretical training on the importance of nutrition and the principles of enteral nutrition. In the laboratory applications, the steps of enteral nutrition were first demonstrated, and then each student was given the opportunity to practice. Students were given sufficient time to develop the skills required to comply with the rules of enteral nutrition. Each student in the control group performed individual applications. At the end of the training, students were asked to complete the “Enteral Nutrition Knowledge Test” as a final test (May 31, 2024). To measure the retention of knowledge, the same test was administered again 4 weeks after the final test (June 28, 2024).

The ethical dimension of the research

Within the scope of the ethical evaluation of the study, ethics committee permission dated 02 May 2024 and numbered E-XXX was obtained from the Non-Interventional Clinical Research Ethics Committee of the university where the study will be conducted. After obtaining the ethics committee permission, research permission dated 13 May 2024 and numbered E-XXX was obtained from the department and dean’s office where the study will be conducted. Permission was obtained from the students within the scope of the informed consent form. Participation in the study was completely voluntary, and the participants were informed that there would be no situation that would affect the course intake and academic success of the students if they did not participate in the study. This study was conducted in accordance with the Declaration of Helsinki.

Data analyses

The data of the study were analyzed with SPSS (version 25.0; SPSS, Inc., USA) software. Number, percentage, mean, standard deviation, minimum, and maximum were determined by descriptive statistical methods. The normality of the data was evaluated by the Kolmogorov-Smirnov test. In the analysis of normally distributed data, the independent sample t-test was used for two independent group comparisons, and the dependent sample t-test was used for two dependent group comparisons. The difference between repeated measures was analyzed by repeated measures ANOVA, and Bonferroni multiple comparison tests were used to determine the groups showing differences. In the evaluation of effect size, d:0.1–0.3 had small effect, d:0.3–0.5: had a medium effect, d:0.5 and above had strong effect [19]. The significance level was accepted as p < 0.05 in the evaluation of the data.

Results

No statistically significant differences were observed between the experimental and control groups with respect to the distribution of participants’ demographic characteristics, and the groups were found to be homogeneous in terms of gender (p > 0.05) (Table 1).

Table 1.

Descriptive characteristics of nursing students

Characteristic	Groups				Statistics
	Experimental		Control
	n (45)	%	n (45)	%
Age (x̄±SS) / Median	20.20 ± 3.16/20.0		19.89 ± 1.84 /20.0		Z=-0.263 p = 0.792
Gender
Famale	28	62.2	35	77.8	χ2 = 2.593 p = 0.107
Male	17	37.8	10	22.2
Choosing the nursing department at your own request
Yes	30	66.7	29	64.5	FE = 4.789 p = 0.079
No	2	4.4	2	4.4
Partially	13	28.9	14	31.1
Previous training in collaborative learning
Yes	4	8.9	3	6.7	CC = 0.000 p = 1.000
No	41	91.1	42	93.3

Z: Mann Whitney U test; FE= Fisher Exact Chi-square; χ² = Pearson Chi-square, CC = Yates correction

p < 0,05

The experimental group demonstrated significantly higher post-test knowledge scores compared with the control group (p = 0.007), with a medium effect size (d = 0.587). In addition, the experimental group’s retention test knowledge scores were significantly greater than those of the control group (p < 0.001), reflecting a large effect size (d = 1.079). Within-group analyses revealed statistically significant changes over time in both the control and experimental groups (p < 0.05). Post hoc comparisons indicated significant differences among pre-test, post-test, and retention test scores in both groups, as well as a significant difference between post-test and retention test scores (p < 0.001). The effect size was calculated as 0.613 for the control group and 0.857 for the experimental group, indicating a stronger effect in the experimental group (Table 2).

Table 2.

Pre-test, post-test and follow-up test knowledge scores of students in the control and experimental groups

Knowledge scores	Groups						Effect size	Statistics
	Experimental groups (n = 45)			Control group (n = 45)
	x̄±SD	Min	Max	x̄±SD	Min	Max
Pre-testA	31.8 ± 12.89	0.00	75.00	34.78 ± 10.92	10.00	55.00	-	t = 1.191 p  = 0.237
Post-testB	59.22 ± 7.46	50.00	75.00	52.78 ± 13.59	30.00	80.00	0.58	t=-2.788 p  = 0.007*
Follow-upC	68.67 ± 6.78	55.00	85.00	57.22 ± 13.38	25.00	85.00	1.07	t=-5.119 p  < 0.001*
Difference between groups	A < B < C			A < B < C
Effect size	0.857			0.613
Statistics	F = 262.684 p  < 0.001*			F = 69.738 p  < 0.001*

t: Independent sample t test; F: ANOVA for repeated measures; Min: Minimum; Max: Maximum

*p < 0,05

Statistically significant differences were identified in all post-test measurements of the self-directed learning skills scale within the experimental group (p < 0.001). Subscale analyses indicated significant increases from pre-test to post-test in self-monitoring (p < 0.001; d = 4.502), motivation (p < 0.001; d = 5.398), self-control (p < 0.001; d = 3.700), and self-confidence (p < 0.001; d = 6.034), with all effect sizes classified as large. Moreover, a significant improvement was observed in the total scale scores of the experimental group between pre-test and post-test measurements (p < 0.001), accompanied by a large effect size (d = 5.445) (Table 3).

Table 3.

Self-directed learning skills scale pretest and posttest scores of students in the control and experimental groups

Scale and sub-dimensions		Groups						Statistics 1
		Experimental group (n = 45)			Control group (n = 45)
		x̄±SD	Min	Max	x̄±SD	Min	Max
Self -monitoring	Pre-test	9.93 ± 2.70	16.00	25.00	21.16 ± 2.64	14.00	25.00	t = 0.395 p = 0.694
	Post-test	8.47 ± 2.83	14.00	25.00	21.16 ± 2.64	6.00	20.00	t = 22.026 p  < 0.001*
	Effect size	0.44			-
	Test Statistics 2	t = 2.859 p  = 0.006*			- -
Motivation	Pre-test	21.58 ± 2.51	17.00	25.00	21.42 ± 3.07	13.00	25.00	t=-0.263 p = 0.793
	Post-test	7.49 ± 2.70	5.00	14.00	21.42 ± 3.07	13.00	25.00	t = 22.850 p  < 0.001*
	Effect size	5.398			-
	Test Statistics 2	t = 26.548 p  < 0.001*			- -
Self-control	Pre-test	24.42 ± 3.33	17.00	30.00	25.07 ± 3.09	18.00	30.00	t = 0.952 p = 0.344
	Post-test	10.76 ± 3.97	18.00	30.00	25.07 ± 3.09	6.00	26.00	t = 19.104 p  < 0.001*
	Effect size	3.700			-
	Test Statistics 2	t = 17.411 p  < 0.001*			- -
Confidence	Pre-test	17.20 ± 1.95	13.00	20.00	17.22 ± 2.40	10.00	20.00	t = 0.048 p = 0.962
	Post-test	5.58 ± 1.90	4.00	10.00	17.22 ± 2.40	10.00	10.00	t = 25.504 p  < 0.001*
	Effect size	6.034			-
	Test Statistics 2	t = 29.536 p  < 0.001*			- -
Scale Score Average	Pre-test	88.47 ± 9.74	70.00	105.00	89.29 ± 10.54	58.00	105.00	t = 0.384 p = 0.702
	Post-test	33.73 ± 10.34	75.00	105.00	89.29 ± 10.54	58.00	90.00	t = 25.236 p  < 0.001*
	Effect size	5.445			-
	Test Statistics 2	t = 25.643 p  < 0.001*			- -

¹Test statistics: Independent sample t test

²Test statistics: Dependent sample t test

Min: Minimum; Max: Maximum

*p < 0.05

Discussion

In 21st -century health policies, the positive benefits of technology integrated into learning methods and increased quality of education have become important [17]. Interactive education methods, whose applicability increases with the possibilities of technology, are of great importance in increasing the critical perspective and interaction between students while encouraging high-level thinking [2]. One of the interactive education methods frequently used today is the collaborative learning method. In this study, nursing students’ knowledge and skill learning about enteral nutrition was guided by the collaborative learning method, and positive results were observed.

In this study, it was found that the post-test knowledge scores of the experimental group trained with the collaborative learning method were statistically significantly higher than the control group (Table 2). In Wu’s study in a university in Taiwan, a collaborative learning method was applied to increase the mental health and nursing competence of nursing students in clinical practice, and it was observed that the academic and technical performances of the students were positively affected [20]. In the by Yang et al. in another study in which the collaborative learning method was applied to increase success in a simulation-based pediatric nursing course, it was observed that the knowledge level of the students in the intervention group increased significantly [17]. In the conducted by Balkaya et al. in a study conducted with nursing students on reproductive health, it was concluded that collaborative learning and interactive education methods increased academic success in students and had a positive effect on motivation and self-confidence [21]. In the by Magi et al. in another study linking nursing practice and education and applying the collaborative learning method, the perspective of nurses participating in master’s degree education in nursing as student-academician was examined and it was found that collaborative learning was effective in developing knowledge and skills of nurses at different stages of their careers [16].

In this study, a collaborative learning approach to enteral nutrition education provided to nursing students resulted in a statistically significant increase in their knowledge (Table 2). This study’s findings are consistent with studies on the same topic in the literature [16, 17, 20, 21]. This result demonstrates the success of collaborative learning on students’ behalf. The communication among students at the university where the study was conducted enhanced this success. The communication between the student group, who met enteral nutrition for the first time, provided a dynamic environment to increase knowledge. Students studied by having fun with each other. Examining different information by dividing into groups, students’ cooperation, and exchange of ideas with each other made the information permanent. In the study, it was seen that the retention test knowledge scores of the experimental group students were statistically significantly higher than the control group (Table 2). This result reveals the success of the collaborative learning method.

Another finding of the study relates to self-directed learning skills. The study found a statistically significant difference in the final test scores of the self-directed learning skills scale across all measurements (Table 3). In a study conducted by Incesu and colleagues with nursing students on self-breast examination, it was concluded that web-based education delivered through a collaborative learning model increased student success, while collaborative learning positively affected students’ “motivation” and “self-control” skills [22]. Wang and colleagues’ study emphasized that nursing students’ clinical thinking skills developed with collaborative learning and that “self-monitoring,” one of the self-directed learning skills, increased [23]. Knof and colleagues’ study found that teaching anatomy using collaborative learning methods increased students’ self-directed learning skills, particularly strengthening the “motivation” sub-dimension [24]. In a study conducted by Govindan and colleagues with nursing students taking Anatomy and Physiology courses, it was found that education provided through collaborative learning resulted in a significant increase in the “self-monitoring” level of self-directed learning skills [25]. In a study by Bıyık Bayram and colleagues, who used collaborative learning methods to teach nursing students how to measure blood pressure correctly, a significant increase was observed in students’ “self-monitoring,” “motivation,” and “self-confidence” scores [26].

In this study, which examined the subscales of the self-directed learning skills scale in conjunction with the collaborative learning method, statistically significant increases were observed in the experimental group compared to the control group in the dimensions of “self-monitoring,” “motivation,” “self-control,” and “confidence” (Table 3). A review of studies in the literature on this subject revealed that this study is consistent with the literature [22–26]. Collaborative learning created social interaction among students. During this interaction, students who were unable to perform enteral feeding-related skills were seen to increase their knowledge levels by supporting each other within the group work. This situation increased students’ self-confidence and motivation through social interaction. In addition, it was observed that students’ self-regulation and critical decision-making skills were strengthened to achieve long-term goals. Students who learned while communicating with each other increased their permanent learning. These results suggest that students enjoyed the research method and felt more comfortable asking each other questions. In other words, they demonstrated that working with each other was enjoyable and that collaborative learning was beneficial through an increase in self-directed learning skills. In addition, the small number of teaching staff in this study presented some disadvantages. Teaching staff had to allocate time to each group in turn. It is believed that in small group studies where interactive teaching methods are used, the number of teaching staff should be equal to the number of groups.

This study’s focus on enteral nutrition, storage conditions for enteral nutrition, and key points to consider during enteral feeding, as well as the fact that this training was conducted using a collaborative learning method, highlights its originality. In addition to this unique aspect, the development of self-directed learning skills has earned this study a prominent place in the literature. The increase in both the knowledge level and self-directed learning skills of nursing students has not only earned its place in the literature but will also serve as an important guide for faculty members. Ensuring that nursing students, as future caregivers, possess adequate knowledge and skills regarding enteral nutrition is crucial for infection control, particularly for reducing aspiration pneumonia rates. This is crucial for improving patient quality of life and reducing healthcare costs. In light of these findings, collaborative learning should be a guideline for all nursing intervention studies.

Limitations

Among the limitations of this study are that it was conducted only with first-year nursing students taking the Fundamentals of Nursing course at one university, and that it is unclear whether the students in the control group were informed about the study and whether they developed their self-directed learning skills. Since data were collected through self-reporting, there is a risk of bias; however, anonymity and confidentiality were emphasized to encourage students to respond honestly. Although the study was conducted with a specific group of students, the results are consistent with situations commonly encountered in the clinical experiences of nursing students and provide insights that can be generalized to different institutions. Although relying on self-reporting creates limitations, it has the strong quality of directly reflecting participants’ real experiences and perceptions. Supporting these limitations with future multi-center, larger sample, or longitudinal studies will increase the generalizability of the findings.

Conclusion

This study emphasizes that the collaborative learning method increases success in nursing students. Students reinforced learning by communicating and cooperating through small group studies to develop knowledge and skills about enteral nutrition. Group work among students supported permanent learning. In this study, students who applied the collaborative learning method received a full score of 105 on the self-directed learning skills scale, a full score on the post-test. This result was statistically significant. This demonstrates the need for instructors to integrate collaborative learning into the education system to learn accurate knowledge and skills. This study focused on enteral nutrition, which constitutes a significant portion of nutritional requirements. It is recommended that collaborative learning be implemented across different courses with a sufficient number of instructors in teaching basic nursing skills.

Authors’ contributions

Aysun Acun and Rahime Aksoy Bulgurcu made significant contributions to writing the original manuscript and data analysis. Aysun Acun and Rahime Aksoy Bulgurcu conducted the survey, data collection, and visualization. Aysun Acun was responsible for conceptualization, supervision, and writing review and editing. Aysun Acun is the first author. Rahime Aksoy Bulgurcu is the second author. All authors read and approved the final manuscript.

Funding

No additional funding was received for this study.

Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Within the scope of the ethical evaluation of the study, ethics committee permission dated 02 May 2024 and numbered E-10333602-050.04-253963 was obtained from the Non-Interventional Clinical Research Ethics Committee of the Bilecik Şeyh Edebali University where the study will be conducted. After obtaining the ethics committee permission, research permission dated 13 May 2024 and numbered E-32646225-900-254230 was obtained from the department and dean’s office where the study will be conducted. Permission was obtained from the students within the scope of the informed consent form. Participation in the study was completely voluntary, and the participants were informed that there would be no situation that would affect the course intake and academic success of the students if they did not participate in the study. This study was conducted in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.