Postgraduate nursing students’ experiences in a project-based learning model: a qualitative focus group study

Abstract

Background

Due to the increasing complexity of global health issues, educators must adopt innovative pedagogical approaches in master’s education to cultivate advanced health professionals. Project-based learning (PBL) is an effective method, yet evidence on how it achieves its pedagogical outcomes and influences postgraduate nursing students’ development is limited. This study aimed to describe the experiences of postgraduate nursing students engaged in a PBL model within a scientific research training course and to explore the key elements that impact their knowledge, competencies, and affective thinking.

Methods

This study used a qualitative approach. Twenty-one postgraduate nursing students enrolled in a scientific research training course were interviewed through face-to-face and online. Data were collected through semi-structured focus group interviews. Thematic analysis was used to analyze interview data.

Results

The qualitative study revealed five themes, external stressors: multiple challenges to capacity, external supportive forces: the teacher as a positive enabler, endogenous forces: self-directed learning from facilitation to reinforcement, sense of accomplishment, and curriculum design for future student needs.

Conclusions

This study identifies key elements of effective implementation of the PBL educational model that enable students to have a good course experience and promote knowledge, skills and thinking.

Introduction

The world is currently facing severe challenges of increasing health issue complexity and a rising number of comorbid patients, directly requiring advanced nursing professionals to have core competencies including clinical nursing skills, critical thinking, and research capabilities [1]. However, current postgraduate nursing education predominantly relies on teacher-centered instructional approaches and often fails to adequately foster interdisciplinary competencies [2, 3]. These limitations can constrain students’ cognitive flexibility and hinder the development of their innovative potential [4]. Therefore, it is imperative to integrate learner-centered pedagogical innovations into postgraduate nursing education, in order to effectively develop students’ integrated competencies.

Project-based learning (PBL) is a student-centered instructional approach that engages learners in solving authentic, complex problems, thereby fostering the integration of knowledge and the development of systematic cognitive frameworks and practical skills [5, 6]. Currently, PBL has been widely applied in various education contexts and has achieved significant and visible outcomes in terms of student satisfaction, knowledge acquisition, self-regulated learning abilities and teamwork abilities [7–9].

Postgraduate nursing education aims to cultivate advanced, versatile nursing professionals, which necessitates a deep integration of theory and practice [10, 11]. In this context, PBL has emerged as a key pedagogical approach. Its emphasis on authentic, inquiry-based, and reflective learning closely aligns with the advanced competencies required at the postgraduate level. Implementing PBL through action-oriented projects not only addresses the inherent limitations of traditional teaching methods but also engages students in solving complex real-world problems through self-directed inquiry and collaborative problem-solving. This approach effectively integrates theoretical understanding with practical application, thereby supporting the comprehensive development of nursing postgraduates. However, existing applications and research on PBL have largely focused on undergraduate nursing education [8, 9, 12], with limited studies examining its implementation in postgraduate programs. Therefore, further investigation at the postgraduate level is needed.

The effectiveness and successful implementation of PBL are reflected in its ability to stimulate key factors during the process, such as teacher’s guidance, self-directed inquiry, and reflection [13]. However, empirical evidence documenting these process factors remains scarce. Most studies have focused primarily on outcomes related to academic performance and cognitive skills [5, 14], with insufficient attention to how students engage in exploratory learning or undertake iterative reflection and revision. Furthermore, as many investigations adopt quasi-experimental designs [15–17], they often fail to capture the dynamic trajectories of these learning processes. There is also a lack of consensus regarding the emergence of affective, cognitive, and self‑directed learning outcomes, as well as their subsequent impact on students [18]. Consequently, additional qualitative evidence is required to unpack these complex processes.

The scientific research training course is an essential component of postgraduate nursing education. In this study, the PBL model was implemented within the course, and a qualitative investigation was conducted. The aim was to examine the implementation and influencing factors of PBL in the postgraduate curriculum, thereby contributing to the process-oriented evidence and offering insights for educators seeking to enhance the effectiveness of PBL. The objectives of this study were: (1) to evaluate the implementation effectiveness of PBL in the research training course from the students’ perspective; and (2) to analyze the impact of PBL on students’ development and identify the key influencing factors.

Methods

Design

This qualitative study explored graduate nursing students’ learning experiences in a project-based scientific research training course [13]. Data collection was conducted through semi-structured focus group interviews [19] within one month after the completion of the Spring 2024 course. Thematic analysis [20] was used to identify themes at various stages of the study, and the final qualitative findings were reported following COREQ guidelines [21].

Intervention

Theoretical basis

The core principle of constructivism is that learning is an active process where learners connect prior knowledge with new information through environmental interactions, constructing meaningful understanding [22, 23]. Based on this, constructivist theory was selected as the foundation for instructional design and research, integrating elements such as scenarios, collaboration, and discussion into task design [24].

Program design

The scientific research training course was taught by the corresponding author of this study and focused on the core content and themes of basic theoretical knowledge and methods in nursing research. This course was designed based on the project-based learning model and comprised four sequential projects: the implementation of flipped classroom activities [25], the completion of a research proposal, peer assessment, and a final reflective journal. Students were required to complete these projects in the designated order as the course progressed. Figure 1 presents the timeline for the implementation of these projects, their core content, and the corresponding assessment methods.

Fig. 1.

Course design with PBL integration: from task release to assessment

Participants and setting

Participants were recruited using a purposive sampling strategy to ensure they had direct and recent experience with the PBL intervention and to select those capable of providing information-rich data on the phenomenon. Given that the study prioritized inclusivity over a predetermined sample size, all eligible students from the spring 2024 science training course who met the inclusion criteria were invited to participate. The inclusion criteria were: (i) students who had completed all projects, as well as other spectator students who had participated in at least 80% of the course; and (ii) those willing to provide written informed consent before participating in this study.

Four focus groups of 5–6 participants each were formed, encompassing nearly the entire participant pool. The number of groups was determined by the need to balance in-depth interaction with practical management, and their adequacy is confirmed by the achievement of thematic saturation.

Data collection

The communicative and interactive nature of the focus groups fostered a relaxed atmosphere, which enhanced the depth and diversity of the data collected [19]. Accordingly, four focus group interviews were conducted in this study. Face-to-face interactions were prioritized for data collection and observation, though three groups participated in in-person interviews, while one group of five students, due to personal reasons, participated online via Tencent conferencing software. Each focus group was led by two researchers: one facilitated the semi-structured interviews, and the other observed, supplemented discussions, and took field notes. The interview followed a semi-structured interview protocol based on the research aims (Table 1). Before the interviews, participants were encouraged to thoroughly review the interview protocol and complete a general situation survey form.

Table 1.

Interview script

Interview Questions
What were your expectations for the scientific research training course before the course began?
What was an enjoyable or unpleasant experience you had in this course?
How do you like the project-based learning model in this course?
How the learning model in this course has impacted you༟
How do you think the learning model in this program differs from those in other programs?
What did you gain from the course?
What are your opinions and suggestions on the current implementation of project-based learning?

The questions were flexible and adjusted based on participants’ responses. Each focus group lasted 60 to 90 min and was audio-recorded. Data saturation refers to the point in data collection and analysis at which no new substantive codes or themes related to the research questions emerge [26]. This criterion was met upon completion of all four planned focus groups and the analysis of reflective journals. Consequently, data saturation was confirmed, and data collection was concluded.

Data analysis

Thematic analysis was performed following Braun and Clarke’s six-phase qualitative framework [20]: (1) immersion through repeated reading of the transcripts; (2) systematic generation of initial codes; (3) collation of codes into candidate themes; (4) iterative review and refinement of themes against the full dataset; (5) final definition and naming of themes; and (6) contextualization of themes in light of the research questions and relevant literature. To enrich contextual depth, participants’ reflective journals were incorporated as supplementary textual data. All qualitative data were managed and coded systematically using NVivo 11 software.

Two researchers (S.X.W. and Y.Y.) conducted the coding under the supervision of a senior investigator (Y.C.W.). The process began with independent coding of an initial transcript subset by both coders. Regular consensus meetings were then held (initially weekly) to compare coding outcomes, resolve discrepancies, and collaboratively develop and refine the coding framework. This iterative process continued with subsequent transcripts until data saturation was achieved. Upon completion of the analysis, the entire research team reviewed the codes and themes to produce the final report. A step-by-step exemplar of the coding process, illustrating the progression from raw data extracts to final themes, is provided in Table 2.

Table 2.

Exemplar of the thematic analysis process: from data to themes

Data Extract	Initial Code	Sub-theme	Main Theme	Analytical Note
“I believe the teacher’s questions during class are not necessarily a sign of disapproval; rather, they often indicate that she thinks my perspective lacks depth and wants to help me think more thoroughly.” (Student 1)	Reinterpreting questioning as support for deeper thinking	Conceptual and professional identity development	Sense of accomplishment	The psychological shift of students from incomprehension to comprehension of teaching arrangements reflects their perceived growth in knowledge and mindset.
“Initially, I wondered why the teacher chose this approach, believing that a more traditional teaching style would be more professional and effective. However, by the end, I realized that this method allowed us to express ourselves and facilitated significant learning.” (Student 8)	The shift in thinking from not understanding to understanding

Rigor

To strengthen the reliability and rigor of the study [27, 28], multiple strategies were implemented. Investigator triangulation was used during data analysis, and interview transcripts were returned to participants for verification. Additionally, the research team conducted iterative discussions across several stages to review and reach consensus on the findings. Themes were supported with direct quotations from participants. To enhance transparency and ensure confirmability [29], extensive contextual excerpts are included in the results section.

It is explicitly acknowledged that the corresponding author served as the instructor of the course under investigation. To mitigate potential bias arising from this dual role, specific procedural safeguards were implemented throughout the study: (1) During data collection, this author did not moderate any focus group interviews involving their own students to foster open dialogue. (2) In the primary coding phase, initial line-by-line coding of all transcripts was conducted independently by two other researchers, ensuring that foundational data interpretation originated from perspectives external to the instructor-student relationship. (3) During theme development and validation, all authors, including the instructor, participated in consensus discussions. In these sessions, the instructor’s contextual insights were critically examined against the coded data and the interpretations of fellow researchers. This approach allowed for the constructive integration of the instructor’s in-depth understanding while rigorously safeguarding against confirmation bias. Furthermore, during the informed consent process, participants were assured that their involvement and responses would not affect their course grades or academic standing, and all data were anonymized.

Ethical considerations

Ethical permission to undertake the study was granted by the Hubei University of Chinese Medicine Committee (2024015). Before the start of data collection, participants were informed of the purpose of the study and their right to withdraw at any time. They were also provided with a code in the transcribed text to ensure the confidentiality and anonymity of the information.

Results

Participant characteristic

A total of 21 students participated in the study, including 19 females and 2 males. The ages of the students ranged from 22 to 36 years (24.67 ± 4.00). The qualitative analysis revealed four major themes that are summarized in Table 3.

Table 3.

Main themes, sub-themes and representative quotes

Main themes	Sub-themes	Representative quotes
External stressors: multiple challenges to capacity	Conflict between time and energy	“At the beginning, we were suddenly given only one week to confirm our research topic, and then had to complete all the content the following week. That was quite stressful.” (Student 6) “I felt the teacher assigned projects too quickly; I hadn’t fully finalized my topic selection yet but had to start immediately.” (Student 8) “During my postgraduate studies, besides this course, I had other coursework assignments. Trying to allocate all my time to prepare for this PBL content would have been too tight and challenging.” (Student 21)
	Challenges of task complexity and competency gaps	“It was not my area of expertise. I had no experience with qualitative research, so when I presented on it, I found the content rather obscure myself. It seemed that my classmates also found it difficult to follow, as few students appeared to be listening.” (Student 3) “I could not accurately judge whether others’ research proposals were well-written or not. I only evaluated them based on my own understanding and did not make substantial revisions to their content.” (Student 4)
External supportive forces: the teacher as a positive enabler	A project-oriented facilitator	“The teacher reviewed the completion status of my project and returned it to me for revisions. I believe she helped me clarify the logical structure from her professional perspective.” (Student 5) “When I was presenting, the teacher raised critical questions that prompted me to think more deeply about knowledge points I might have overlooked.” (Student 6)
	An emotional supporter	“I was very nervous during my first presentation, but after the teacher encouraged me, I felt much more at ease.” (Student 8)
	A professional role model	“I feel the teacher’s influence on me has been subtle and gradual, as she inherently serves as a role model.” (Student 13) “I find the teacher to be extremely dedicated.” (Student 6)
Endogenous forces: self-directed learning from facilitation to reinforcement	Driving force	“I also aimed to develop my research thinking skills, and more fundamentally, to better facilitate my future career development plan.” (Student 15) “My goal was to learn systematic research methodologies.” (Student 20)
	Ongoing scrutiny and reflection	“In connecting this learning experience with my clinical practice, I reflected on my previous patient interviews and identified several shortcomings. For instance, I failed to grasp the key points during these interactions.” (Student 11 - Reflective Diary) “I had several language expression issues during my presentation, particularly the overuse of filler transitions like ‘then’, which may have negatively impacted my classmates’ listening experience.” (Student 12 - Reflective Diary) “There were some errors in my work that I had not noticed myself, but my peers identified them and provided detailed, thoughtful comments that clearly pinpointed the issues.” (Student 13)
	Adjusting mindset to foster resilience	“I viewed it as a learning process; completing it allowed me to familiarize myself with the overall workflow.” (Student 1) “Even if the outcome was not ideal, the work I had done and the time and effort I had invested ultimately yielded valuable gains.” (Student 4)
Sense of accomplishment	Novelty experience	“Presenting it in my own unique way made the experience truly distinct.” (Student 12)
	Knowledge and capacity needs met	“I not only acquired extensive knowledge and skills related to qualitative research but also gained a profound appreciation for both the challenges and rewards of conducting research.” (Student 15 - Reflective Diary) “Through repeated completion of these tasks, I gradually improved my academic writing skills.” (Student 10) “The most significant growth was in my problem-solving skills, which were greatly enhanced through this experience.” (Student 12)
	Conceptual and professional identity development	“I believe the teacher’s questions during class are not necessarily a sign of disapproval; rather, they often indicate that she thinks my perspective lacks depth and wants to help me think more thoroughly.” (Student 1) “There are certain issues and challenges we will inevitably have to face eventually. This process simply helps us sort them out in detail in advance.” (Student 4) “In future scientific research, I will pay greater attention to issues that deeply reflect the complexity of human experiences, as well as data that carries both depth and humanistic warmth.” (Student 13 - Reflective Diary)
Curriculum design for future student needs	Optimizing collaborative learning	“Since each person faces distinct practical challenges, and we have limited understanding of one another’s areas of expertise, we do not invest significant effort in providing mutual guidance.” (Student 2)
	Adding thematic sessions	“If such cases are presented for collaborative group learning, I believe this would yield significant benefits for all of us.” (Student 6)

Theme 1: external stressors: multiple challenges to capacity

This theme reflected the dual pressures of time and capacity faced by postgraduate nursing students in the PBL course. While these pressures essentially highlighted the challenges of role balance and the rationality of project design, it was noteworthy that such stressors compelled students to engage in efficient learning within limited timeframes, activated their learning motivation.

Sub-theme conflict between time and energy

This conflict arose from students’ need to balance multiple academic tasks with clinical practice responsibilities. It highlighted the real-world challenge of reconciling clinical duties with academic research, placing them in a complex and demanding learning environment.

“It’s not convenient for my schedule, and it feels like I’m pressed for time because sometimes I might have other things to do.” (Student 10)

Sub-theme challenges of task complexity and competency gaps

The progressively complex projects revealed a gap between students’ current capabilities and the advanced competencies required, a discrepancy that itself constituted a core learning challenge.

“I read a lot of content when I’m preparing, and I don’t think it’s possible to cover all the points in a short period. Moreover, some students think that they are the key points, and some students don’t need them at all, so it is a difficult point to say exactly what to cover in terms of the arrangement of the lecture content.” (Student 6)

“I didn’t know much about the type of research that goes into this section, so I didn’t give a very substantive opinion, other than to point out foundational errors.” (Student 8)

Theme 2: external supportive forces: the teacher as a positive enabler

This theme illustrated that within the student-centered PBL environment, the teacher’s role evolved to form a structured support system for students’ holistic development. Specifically, these roles involved guiding cognitive construction, providing targeted emotional support, and facilitating professional growth. Rather than merely compensating for students’ gaps, these interrelated functions constituted a coherent pedagogical framework that enabled learners to navigate complexity, sustain engagement, and advance toward autonomous, competent practice.

Sub-theme a project-oriented facilitator

The teacher acted as a project-oriented facilitator in the PBL course, ensuring that students’ learning direction aligned with course objectives. When students’ thinking deviated from the core theme, the teacher helped them refocus their attention on key issues without undermining their autonomy. This guidance was designed to ensure that students’ exploration remains closely connected to meaningful learning outcomes.

“Moreover, each task was clearer, so students knew what they were getting into, which was better.” (Student 6)

“When you shared, if there was some deviation from your point, the teacher acted as a supportive presence, guiding you by repeating your comments.” (Student 1)

Sub-theme an emotional supporter

Acting as an emotional supporter, the teacher mitigated students’ course-related stress through validating their perspectives and delivering constructive feedback. This supportive engagement increased students’ participation in discussions and cultivated an inclusive, low-pressure learning environment.

“If you answered the correct answer, the teacher would give you some encouragement, so I think that incentive was pretty good.” (Student 21)

“It would also bring the whole classroom together.” (Student 6)

Sub-theme a professional role model

Through consistent verbal guidance and behavioral demonstration, the teacher embodied a professional role model that integrated rationality with empathy. This modeling provided students with a tangible reference point, guiding them to envision their future professional roles and develop corresponding competencies. Consequently, it laid a solid foundation for their holistic growth as future nursing scholars and clinical practitioners.

“From the questions and exchanges that impressed me in class, I realized that the teacher was a rational and emotional person who pursued her life goals while valuing her inner world, which was infectious to me in terms of her expectations regarding personal thought.” (Student 7 - Reflective Diary)

Theme 3: endogenous forces: self-directed learning from facilitation to reinforcement

This theme revealed that the development of self-directed learning within the PBL model followed a dynamic trajectory, evolving from initially triggered motivation to the sustained reinforcement of learning behaviors. Students first engaged in learning driven by varied motives. Through ongoing interactions, reflection prompted conscious cognitive and behavioral adjustments aimed at addressing perceived gaps. This virtuous cycle progressively transformed self-directed learning from an externally stimulated practice into an internalized drive rooted in the pursuit of self-improvement.

Sub-theme driving force

The initial motivations for self-directed learning were primarily categorized into two types: task-based motivation centered on course credit completion, and intrinsic motivation focused on self-improvement. While these two types of motivation stemmed from students’ distinct pursuits, both served as core catalysts for sparking their autonomous inquiry in the PBL course.

“Nothing special just wanted to get credits.” (Student 11)

“The biggest significance was that I could work my way through and write a paper about the aspects of what I wanted to write about and then realized my worth.” (Student 16)

Sub-theme ongoing scrutiny and reflection

The PBL course fostered collaborative interactions among students and between students and teachers. Within these interactions, feedback from peers and the teacher not only helped correct errors but also prompted students to actively scrutinize their own reasoning, thereby encouraging ongoing self-reflection. This reflective process enhanced the development of students’ critical thinking and enabled them to identify areas for improvement more clearly.

“Afterward, I kept thinking about the questions the teacher asked me in class, and even though it was over, I still thought about it on my own and urged myself to do better next time. And then in the peer review research proposal section, I would learn some advantages from others and then compare myself.” (Student 2)

“I began to reflect on my past attitudes towards life experiences, and learned to be attentive to every detail and draw nourishment for growth from them.” (Student 6- Reflective Diary)

Sub-theme adjusting mindset to foster resilience

Through reflective practice, students actively reconstructed their cognitive and affective strategies in response to challenges. They reframed difficulties as opportunities for growth and internalized a commitment to lifelong learning. Such self‑regulated adjustment not only sustained their learning motivation but also progressively strengthened their autonomous, self‑directed learning behaviors.

“It doesn’t matter to me (the content schedule) because any content is new to me and I need to learn it, so whichever one.” (Student 10)

Theme 4: sense of accomplishment

This theme captured a multi‑layered sense of accomplishment that extended beyond task completion or grades. Students reported an integrated gain comprising knowledge acquisition, emotional satisfaction, and a strengthened sense of self‑identity. This perception originated from the novel, inquiry‑driven nature of the PBL experience, which engaged them affectively and cognitively. As their knowledge and skills advanced, core learning needs were met, thereby reinforcing their confidence in addressing complex challenges. Ultimately, the most profound outcome was perspectival and cognitive shifts. These transformations signified meaningful development in self‑awareness and demonstrated that PBL can effectively foster long‑term professional growth and adaptive capacity.

Sub-theme novelty experience

Students perceived the PBL-integrated curriculum experience as significantly more novel, which indicated that the interactive and inquiry-based experiences embedded in the PBL model elicited positive emotional responses among them.

“The format of the course was new to me and very useful.” (Student 18)

“Especially presenting it in its unique way, I believe this experience is entirely different.” (Student 12)

Sub-theme knowledge and capacity needs Met

Students recognized that the PBL inquiry process not only prompted them to internalize and assimilate theoretical knowledge but also systematically enhanced their core professional competencies. The alignment between the PBL curriculum and students’ intrinsic knowledge and competency needs, along with the enhanced sense of achievement in knowledge and skill acquisition, strengthened their confidence in addressing complex academic and professional challenges.

“Since the flipped classroom involves a lot of reading and preparation, I have to keep motivating myself to engage in these learning activities. Throughout this process, the teacher provided specific feedback, prompting continual revisions. Consequently, I believe that at this stage, graduate students experienced significant improvement in their skills.” (Student 15)

“The more you learned, the clearer your thoughts became, and then if you knew more and more, you might slowly start to feel that it is not so difficult, anyway, it was a process from bad to good.” (Student 10)

Moreover, the distinctive project design accommodated students’ unique developmental needs and provided them with space to practice and develop their abilities.

“I think it honed my lecture skills, I guess!” (Student 3)

Sub-theme conceptual and professional identity development

Under the PBL model, students achieved personal growth through completing projects via self-directed learning, transforming from initially avoiding pressure to proactively addressing difficulties. This process fostered a stronger sense of intrinsic self-worth and professional identity. Concurrently, their attitudes toward innovative pedagogical approaches shifted from skepticism to genuine understanding and acceptance. These transformations confirm that the PBL model not only delivers knowledge-based gains to students but also facilitates the reshaping of their self-perception.

“As a postgraduate student, it’s crucial to identify and solve problems while exploring new methods constantly. Despite my shortcomings, I must not dwell on the past. I hope to cultivate greater resilience, enabling me to recognize my worth truly.” (Student 14 - Reflective Diary)

“Initially, I wondered why the teacher chose this approach, believing that a more traditional teaching style would be more professional and effective. However, by the end, I realized that this method allowed us to express ourselves and facilitated significant learning.” (Student 8)

Theme 5: curriculum design for future student needs

This theme identified a disconnect between curriculum design and students’ developmental needs, as revealed through their participation in the PBL program. Students’ expressed needs for enhanced collaboration and personalization indicated that effective PBL should not only follow standardized procedures but also support individualized professional development.

Sub-theme optimizing collaborative learning

Due to various constraints in the flipped classroom projects, students did not achieve deep peer collaboration. This finding highlighted two related limitations in the PBL implementation: first, some projects prioritized mechanical, individual task completion over substantive collaborative inquiry, thereby failing to balance self‑regulated and collaborative learning; and second, there was an absence of supportive peer resources. In response, students proposed specific strategies to enhance collaborative learning outcomes.

“In effect, each of us completed our respective portions independently. This approach hindered the potential for mutual learning between us, as we were not closely aligned in terms of the content we were responsible for teaching.” (Student 5)

“I think that if you add some people from other disciplines when appropriate, the effect of the lectures may be different.” (Student 15)

Sub-theme adding thematic sessions

Clinically oriented students expressed a need for more courses focusing on clinical intervention methodology. This need highlights the lack of specialized content tailored to different professional tracks in the current curriculum design. Thus, their demands reflect an urgent need for the curriculum system to integrate academic inquiry with discipline-specific professional development.

“The ones that focus on randomized controls for this kind of clinical intervention could go into a bit more detail, as these are methods that everyone can use.” (Student 19)

Discussion

At present, project-based learning has not been widely adopted in postgraduate education, and there has been limited exploration of the process-related factors affecting students. This qualitative study therefore examined in depth the learning experiences of 21 postgraduate nursing students participating in a PBL-integrated course. The findings indicate that as the course advanced, the students underwent a dynamic developmental process, demonstrating positive growth in knowledge acquisition, cognitive skills, emotional engagement, and other key areas.

This study found that students experienced both challenge and accomplishment during the course. Many initially reported that the projects were highly demanding, reflecting a gap between their existing knowledge and the advanced competencies required in postgraduate training. This finding is supported by prior research indicating that stressors may stem from the comprehensive competency requirements expected of students in nursing education programs [30]. PBL helps to bridge this gap by engaging students in meaningful projects that support progressive knowledge construction and competency development. After completing complex tasks, students reported a sense of accomplishment across multiple domains. These positive outcomes demonstrate that PBL effectively enhances students’ knowledge and skills, improves self-regulated learning, and strengthens self-identity, aligning with findings from other studies [31]. Despite these benefits, PBL remains underutilized in postgraduate education in China, constrained by factors such as limited instructional support and insufficient teaching resources [32]. The successful implementation observed in this study further demonstrates that PBL is a viable and effective educational model for postgraduate training, offering a replicable approach for enhancing the quality of nursing education.

This study identified several core elements essential for effective PBL implementation: well-structured project design, adequate teacher support, and the cultivation of self-directed learning awareness among students. This finding not only aligns with previous literature but also provides concrete methodological guidance for practical application [33]. Previous research indicates that high academic stress reduces learning motivation [34]. Accordingly, this study first designed projects that were appropriately challenging and well-aligned with the intended learning objectives—an essential prerequisite for successful PBL implementation. Such projects not only remained feasible within students’ available time and resources but also motivated them to engage in practicing key skills [35]. Second, the supportive role of the teacher served as an external factor. Throughout the PBL cycle, the teacher’s role evolved from an initial facilitator, to a mid-term supporter, and ultimately to a professional role model in the later phase. This progression reflects the constructivist view that teachers should foster an environment conducive to learner autonomy and adjust their guidance according to students’ developmental stages [36]. In this study, this principle was applied through sustained, individualized guidance within a positive learning environment. Such tailored support empowered students, thereby directly advancing their active learning and professional development. Finally, this study further underscores that the success of PBL hinges on its ability to activate students’ self-directed learning, a finding consistent with prior literature [8]. This may be explained by the fact that self-regulated learning behaviors better equip students to adapt to complex and evolving clinical scenarios. This study found that postgraduate students were more capable of promoting and strengthening the self-directed learning process through active reflective practice. This can be attributed to their clinical background, which provides stronger motivation for autonomous learning [37], along with the practical need to apply knowledge in clinical settings [38]. As a result, they tended to use reflection to address cognitive gaps and to sustain self-directed inquiry. This aligns with the constructivist perspective that “learners actively construct knowledge through reflection and social interaction” [36, 39]. However, it is worth noting that few studies have clearly revealed the dynamic process through which self-directed learning in PBL evolves—from initial awareness, through reflective reinforcement, to sustained behavioral engagement. One possible explanation is that undergraduate students who have participated in PBL often lack experience in professional practice settings, which may contribute to relatively weaker reflective skills [40] and less pronounced self-directed learning abilities. Therefore, this indicates that future PBL models applied to undergraduate education should be strengthened in this regard.

Based on the observed effectiveness of PBL in postgraduate nursing education and the improvement suggestions offered by students in this study, this study offers practical insights to help nursing educators successfully implement PBL across diverse teaching contexts. First, it is essential to clarify the learning objectives for different student groups and evaluate their prior knowledge accordingly. For instance, undergraduate nursing students typically need to acquire foundational skills and adapt to a professional role, whereas postgraduate students should focus on synthesizing and applying knowledge to address complex clinical problems [38]. Therefore, educators should design projects that are closely aligned with these objectives, incorporating appropriate levels of difficulty and creative elements to foster student development across multiple domains [4]. Projects should also be intentionally structured for either individual or collaborative learning, rather than being assigned indistinctly. Second, teachers should provide focused guidance, particularly in balancing collaborative and self-directed learning. This study found that self-directed learning outcomes were positive, but collaborative learning did not produce the positive effects reported in other studies [7]. This may indicate insufficient teacher guidance in this area. If teachers can develop appropriate collaboration plans and processes and provide clear guidance in the future, it may improve students’ satisfaction and outcomes during collaborative learning [17]. In addition, process evaluation focused on learning quality, through timely feedback, provides opportunities for student reflection and improvement. Finally, a comprehensive assessment of PBL should not be limited to project outcomes but should include a broader set of indicators to fully evaluate student development [8, 41]. For postgraduate nursing education, it is particularly important to assess how well it aligns with clinical practice and professional needs, which is crucial for accurately understanding the educational value of PBL.

Limitations of the study

This study has several limitations. First, as a qualitative investigation centered on a specific course within Chinese postgraduate nursing education, the transferability of the findings to other educational or cultural contexts may be limited. We have provided a thick description of the course and research setting to assist readers in evaluating the applicability of the results. Second, notably, the corresponding author (Y.C.W) of this study served as the instructor of the course under investigation. This dual role originated from her longitudinal observation of pedagogical challenges in postgraduate nursing education and a dedicated interest in understanding students’ authentic experiences within this innovative PBL curriculum. While this insider perspective offered valuable contextual depth, it also introduced a potential risk of bias. To mitigate this risk, a multi‑layered safeguarding protocol was implemented: the instructor did not participate in focus group interviews or the initial coding process; all team members were involved in thematic discussions; and the instructor’s interpretations were continually examined against the raw coded data and the independent perspectives of other researchers. Participants were also assured that their responses would not affect their academic evaluation, thereby encouraging candid feedback. Nevertheless, we acknowledge that these measures may not fully eliminate the potential influence of the researcher’s involvement in course instruction. Throughout the interpretation of findings, we sought to maintain objectivity through ongoing reflection, team deliberation, and engagement with the broader PBL literature. This limitation underscores the value of future studies that adopt a design fully independent of the teaching context or that incorporate multiple perspectives and time points to enhance the robustness of conclusions.

Conclusion

PBL is an effective and feasible educational approach. In the early stages of the program, students faced multiple projects that could induce stress. However, the active guidance of the instructor enabled them to overcome academic challenges and fostered a positive learning environment. Within this supportive context, students became actively engaged in a variety of knowledge-seeking activities related to the projects. Through ongoing learning and reflection, they not only completed their projects but also contributed to the generation and deepening of knowledge, as well as achieving emotional awareness and personal growth.

Authors’ contributions

S.W. drafted the manuscript, conducted data analysis, and supervised the work in all phases. Y.Y drafted the manuscript, conducted data analysis, and supervised the work in all phases. C.Z. validated the manuscript. H.H. designed the study, validated the manuscript, substantively revised it, and supervised the work in all phases. Y.W. designed the study, validated the manuscript, substantively revised it, and supervised the work in all phases. All authors read and approved the final manuscript.

Funding

This work was supported by the Education Department, Hubei Province [2023362].

Data availability

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Approved by Hubei University of Chinese Medicine Medical Research Ethics Committee (2024015). The study adheres to the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.