The effect of video assisted instruction on central venous catheter application skills, anxiety and satisfaction in nursing students: a randomised controlled study

Abstract

Objective

This study aimed to evaluate the effect of video-assisted instruction on central venous catheter (CVC)-related psychomotor skills (blood collection, drug administration, and dressing care), anxiety levels, and student satisfaction.

Background

Video-assisted teaching has been identified as a potential tool for improving psychomotor competencies, enhancing knowledge retention, and reducing anxiety in clinical practice.

Design

The research employed a randomised controlled trial design.

Methods

The study was conducted at the Atatürk University Faculty of Nursing between May and July 2024 using a cluster-based pre-test/post-test controlled experimental design. Internship groups within a single academic branch were assigned to intervention or control conditions to reduce cross-student contamination. Sixty-six students were included in the study. Both groups received standard theoretical and laboratory-based instruction. In addition, the experimental group was shown training videos. Post-tests were applied one week after the training. Statistical analyses were conducted using SPSS 27, with significance set at p <0.05.

Analyses were conducted at the individual level, and cluster effects were not statistically adjusted.

Results

The post-test scores of students in the experimental group for the "Blood Drawing," "Drug Administration," and "Dressing Care" skills increased significantly (p < 0.05). No significant difference was found in the control group. No statistically significant difference was observed between groups in terms of satisfaction (p>0.05). There was no significant difference between the two groups in terms of post-test anxiety levels (p>0.05). However, baseline anxiety scores differed significantly between groups and may have influenced anxiety-related outcomes.

Conclusions

Video-assisted teaching may improve psychomotor skills in CVC care; however, its effects on anxiety reduction and student satisfaction remain inconclusive. Integrating video-assisted methods with other strategies may enhance both skill acquisition and emotional well-being in nursing education.

Trial registration

ClinicalTrials.gov, NCT07385729. The study was retrospectively registered on 29 January 2026.

Introduction

Nursing education aims to provide students with basic knowledge, skills, and attitudes in affective, cognitive, and psychomotor areas and to ensure that these gains are transformed into behavior in a structure that supports each other with theoretical knowledge and practical parts [1]. Among these areas, the understanding of knowledge and skills falls within the scope of cognitive learning, the development of values and attitudes falls within the scope of affective learning, and the application of physical skills falls within the scope of psychomotor learning [2–4]. Quality and safe patient care in nursing depends on graduates with qualified psychomotor skills. Psychomotor skills are essential to nursing care; without structured practice opportunities, students may have difficulty translating theoretical knowledge into competent clinical performance [5, 6]. In this context, appropriate skill acquisition and maintenance is the key to reducing the risk of skill-based errors and adverse patient events. This is important for patient safety and for students to develop self-confidence and establish good patient relationships [7].

Determining and, at the same time, developing appropriate teaching and learning methods to increase nursing knowledge and skills is an inevitable necessity for academicians providing nursing education [8]. The flexibility, accessibility, and instructional design of learning resources are crucial, enabling learners to review content anytime and anywhere [8]. The primary purpose of the modern education system is to enable students to learn how and where to use knowledge and to create innovations with their existing knowledge [9]. To make learning more active and remarkable in the modern education approach in nursing education, students’ clinical practice competencies are increased through the use of technological resources such as video screenings, role-playing activities, real clinical scenarios, simulated patient applications, and standardized patient use, which increase learning motivation and provide students with the opportunity to learn at their own pace [10–12]. Since one of the essential principles in education is the selection of teaching methods appropriate to the content and learner [13], instructors need to move towards teaching methods in which students play a more active role [9]. Interactive educational videos, one of the most widely used teaching methods for this purpose, are an effective communication and learning tool that engages both the visual and auditory senses of the learner in the acquisition of knowledge and practical skills through demonstrations and theoretical presentations [14, 15]. Since videos can be transmitted through various methods such as mobile devices, they provide high accessibility to the user while giving up-to-date and evidence-based care to the patient [16]. With this method, nursing educators aim to strengthen students’ ability to solve clinical problems and to translate theoretical knowledge into practice through video-recorded scenarios [17]. The literature clearly states that video-assisted teaching is an innovative method to improve undergraduate nursing students’ theoretical knowledge and clinical skills. However, the findings regarding emotional outcomes such as anxiety reduction and student satisfaction are not entirely consistent across the literature. While several studies have reported positive effects of video-assisted instruction on confidence and anxiety reduction, some studies have shown limited or non-significant effects on students’ emotional responses despite improvements in psychomotor skill performance. These inconsistent findings suggest that although video-assisted learning may effectively support procedural skill acquisition, its influence on emotional outcomes may depend on factors such as instructional design, learner characteristics, clinical complexity, and the educational environment. Video-assisted teaching methods may enhance students’ knowledge and skill performance, reinforce confidence in practice, and support learning satisfaction [8, 18–21].

CVC interventions and care skills are among the essential skills that students in the nursing education program have difficulty learning and experience anxiety during practice. Central venous catheters (CVCs), indispensable tools of modern medicine, are used in patients who require intravenous access [22, 23]. CVC interventions, which are a detailed and complex application, affect patients and their relatives economically, socially, and psychologically by causing situations such as prolonged hospital stay, increased risk of infection development, and mortality rate due to deficiencies in care services and practice [24].

Nursing students may struggle to translate theoretical knowledge into practice during central venous catheter (CVC) procedures because these procedures require complex psychomotor skills, strict aseptic principles, sequential procedural steps, and a high level of clinical precision. Compared with many routine nursing procedures, CVC-related practices require simultaneous cognitive decision-making, technical skill coordination, awareness of infection prevention, and adherence to patient safety protocols. In addition, students often have limited opportunities to repeatedly observe and practice these invasive procedures in real clinical environments due to patient safety concerns and restricted clinical exposure. They may experience a sense of fear and anxiety that negatively affects their learning processes as well as their clinical assessment and decision-making competencies due to their lack of sufficient experience during practice in clinical settings. Therefore, video-assisted learning may be particularly beneficial for CVC training because it allows students to repeatedly review complex procedural steps visually and sequentially, supporting both cognitive processing and psychomotor skill acquisition in a low-risk learning environment. At this point, to reduce students’ concerns about clinical practice and increase their self-confidence, it is thought that students’ information needs for clinical training can be met quickly and easily with innovative educational methods accessible via mobile devices and smartphones. In addition, these devices provide learning opportunities outside the classroom and allow students to participate in clinical nursing education remotely. The video-assisted teaching method aims to help nursing students enter the workforce as self-confident practitioners, use critical thinking skills, be ethical and accountable, and be ready to work individually and collaboratively to provide care in various settings. Although research on video-assisted learning in nursing education has increased substantially, the evidence regarding its effects on anxiety and satisfaction remains inconclusive, particularly in technically complex procedures such as CVC care. Furthermore, limited evidence exists regarding the specific impact of video-assisted instruction on CVC-related psychomotor skills, anxiety, and satisfaction outcomes simultaneously. To address this gap, the study’s main aim was to evaluate the effect of video-assisted instruction on drug administration, blood collection, dressing care skills, anxiety levels, and satisfaction with the educational method related to CVC care.

Hypotheses

H1: Video-assisted instruction may improve nursing students’ CVC-related psychomotor skill performance compared with traditional instruction.

H2: Video-assisted instruction may affect nursing students’ state anxiety levels related to CVC applications compared with traditional instruction.

H3: Video-assisted instruction affects nursing students’ satisfaction with the training method compared with traditional instruction.

Method

Research design

The study was designed as a cluster-allocated controlled experimental study. In this study, cluster randomization was preferred to reduce the risk of contamination between students receiving different educational methods within the same clinical skills environment. Because students frequently interacted during laboratory sessions and shared educational materials, allocating individual students within the same practice group could have increased the likelihood of information exchange between intervention arms. Therefore, internship groups within a single branch were used as the unit of allocation. In this study, internship groups constituted the cluster unit. Randomization was performed at the internship-group level rather than at the individual student level to minimize contamination between participants during laboratory-based training and peer interaction. The study was retrospectively registered at ClinicalTrials.gov (NCT07385729) on 29 January 2026 after completion of participant recruitment and data collection. This study was conducted and reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines. The manuscript was revised for grammatical accuracy, clarity, and academic writing style throughout all sections prior to resubmission. The CONSORT 2010 flow diagram is presented in Fig. 1, including participant withdrawals, losses to follow-up, and the final numbers included in the per-protocol analyses, and the completed CONSORT checklist is provided as a supplementary file.

Fig. 1.

CONSORT 2010 flow diagram of participant recruitment, allocation, follow-up, and analysis

Research environment and sampling

The study was conducted at the Faculty of Nursing at Atatürk University. The population consisted of 270 first-year nursing students on the faculty. There are three branches in the Atatürk University Faculty of Nursing. Ninety students in each branch are studying in the 1st year. Within the scope of accreditation, each branch takes the course in the same classroom, and the same lecturer teaches the subject using the same method. There are three branches in this faculty, and students are distributed equally across them based on their academic achievement scores.

The sample size was calculated using G*Power 3.1.9.7. Due to the lack of a similar study, a power analysis was performed based on a moderate effect size (0.5). In this analysis based on the independent-samples t-test model, the margin of error (α) was set as 0.05, and the power (1-β) was set as 0.80. Because statistical analyses were conducted at the individual participant level, the sample size calculation was also performed based on individual-level comparisons rather than cluster-adjusted models. Based on these parameters, at least 34 students should be in each group. Considering the 20% loss rate in the study, 40 students were planned in each group, and 80 students were included. However, 10 students voluntarily withdrew from the study during the intervention, and 4 were absent during post-test data collection. Attrition occurred in both groups (intervention group: n = 7; control group: n = 7), and only participants who completed all assessments were included in the final analyses. Because outcome data were unavailable for participants who withdrew or were absent, intention-to-treat analysis was not performed, and analyses were conducted using a per-protocol approach. Therefore, the study was completed with 66 students. Accordingly, the final analyses were conducted with 66 participants (33 per group). The sample size calculation did not include adjustment for potential clustering effects or intracluster correlation coefficients (ICCs), because clustering was primarily used to reduce contamination between students rather than to estimate hierarchical intervention effects.

Inclusion criteria

• To be a 1st year student in the Faculty of Nursing.

• Taking the Nursing Principles course for the first time.

• Not being absent on the dates when the research data will be collected.

Exclusion criteria

• Students coming by horizontal or vertical transfer.

• Students graduating from Health Vocational High School.

• Students who want to leave the study for any reason during the research process.

Randomization and blinding

To determine in which branch the research would be conducted, the names of 3 branches were written on paper, lots were drawn, and branch B was selected. The students in Branch B who met the research criteria were included in the study. Six internship groups of at least ten students in branch B were formed to prevent possible interaction between the intervention and control groups. Sequence generation was performed using a lottery-based random allocation procedure. Group assignments were determined before the intervention phase by drawing sealed papers labelled as intervention or control groups. Randomization was used to assign internship groups to the intervention or control condition; each group was written on paper, and the first group drawn by lot was designated the intervention group, and the second, the control group. This process was repeated for all groups, and randomisation was completed. Group assignments were determined before the intervention phase, and outcome assessors remained blinded throughout the evaluation process. Branch B was selected using a lottery-based method among the three existing first-year branches. The rationale for conducting the study within a single branch was to minimise contamination between intervention and control groups, maintain consistency in the educational environment, and reduce interaction across study arms during laboratory practices. Since all branches received the same curriculum content from the same lecturer under accreditation standards, Branch B was considered representative of the target population. To further reduce contamination, internship groups were separated during skills training sessions, students in the intervention group were instructed not to share the educational videos with the control group, and the videos were provided to the control group only after completion of the study. In addition, the intervention and control OSCE assessments were conducted separately.

Blinding was applied at the outcome assessment and analysis stages. Outcome assessors were blinded to group allocation. During OSCE evaluations, students were assessed individually using standardized skill checklists, and assessors were not informed about whether the student belonged to the intervention or control group. In addition, students were instructed not to disclose their group allocation or discuss the educational intervention during the assessment process. For data analysis, group labels were coded (e.g., Group A/Group B) to maintain blinding during statistical analyses. The OSCE evaluation sessions for the intervention and control groups were conducted separately to reduce the likelihood of unintentional disclosure of group assignment. Participant blinding was not possible due to the nature of the intervention.

Data collection tools

The research data were collected using the “Personal Information Form,” “Central Venous Catheter Care Skill Evaluation Form,” “Satisfaction Questionnaire with Training Methods,” “State Anxiety Inventory,” and “Training Videos.”

Personal information form

The researchers prepared this form based on the literature on the study’s purpose. The form includes questions to determine the student’s demographic characteristics, such as age, gender, and socioeconomic level.

Central venous catheter care skill assessment form

The Central Venous Catheter Care Skill Assessment Form was prepared to comprehensively evaluate central venous catheter care psychomotor skills and consists of three main sections. These sections were organized as Blood Collection (18 questions), Drug Administration (15 questions), and Dressing Care (17 questions). This 50-item form has a detailed structure for evaluating students’ skills related to central venous catheters. Each procedure step is assessed as “correct” or “incorrect,” each correctly performed step is given 2 points, and incorrect applications are evaluated as 0 points. Thanks to this system, the degree of success of the students in each procedure can be measured.

Subscale evaluation

1. Blood Collection Section: This section evaluates students’ skills related to blood collection from central venous catheters. There are 18 questions, each worth 2 points; the lowest score is 0, and the highest score is 36.

2. Drug Administration Section: This section focuses on drug administration skills and has 15 questions. Students can score between 0 and 30 points in this section.

3. Dressing Care Section: This section evaluates students’ dressing skills, and 17 questions are scored. The lowest score is 0, and the highest is 34.

Total assessment

The form provides an assessment for each section and an overall total. The student’s overall skill level is calculated by totaling the scores in each section. The minimum total score obtained from all sections is 0, and the maximum is 100. A high score on the form indicates that the student has achieved a high level of competence in central venous catheter care. In this way, the performance in each section and a general skill assessment are made.

Regarding the form’s reliability and validity, it was prepared meticulously in line with the literature, and content validity was ensured in accordance with the Ministry of Health application guide. In addition, the form was presented to 10 experts, and the Content Validity Index (CVI) was calculated for each item. Item-level content validity was evaluated using expert ratings, and all items were reviewed and revised in accordance with expert recommendations before finalization. The scale-level content validity assessment demonstrated acceptable content representation for the intended psychomotor skill domains. As a result of the evaluations made in line with the experts’ feedback, it was considered that the form adequately reflected central venous catheter care skills in terms of content coverage and expert agreement. Thus, the form was considered appropriate for evaluating students’ central venous catheter care skills within the scope of this study. In addition to content validity, all skill assessments were conducted using standardized OSCE procedures and predefined evaluation criteria to ensure consistent scoring. Before data collection, the evaluators were informed about the scoring procedures and application steps of the assessment form. To improve scoring consistency during OSCE evaluations, standardized assessment procedures and predefined scoring criteria were used throughout all evaluations. However, formal psychometric analyses such as inter-rater reliability testing and construct validity analysis were not performed. Therefore, although standardized scoring procedures were implemented, the consistency between assessors was not statistically evaluated.

As a result, the Central Venous Catheter Care Skill Evaluation Form provides both sectional and general evaluation, comprehensively evaluates students’ psychomotor skills in central venous catheter care, and reveals their competence.

Training methods satisfaction questionnaire

This 16-item questionnaire was developed by the researchers, and its content validity was evaluated through expert review. The form was submitted to the views of 10 experts; the Content Validity Index (CVI) was calculated from their evaluations; and the questionnaire content was arranged based on their feedback. In this 16-item questionnaire, the change in satisfaction with the training method is measured using five-point Likert-type responses. The scores obtained in the questionnaire indicate the level of satisfaction; a minimum of 16 and a maximum of 80 points can be obtained. Higher scores indicate greater satisfaction. The questionnaire’s reliability was evaluated using Cronbach’s alpha, and a high internal consistency of 0.84 was found. The questionnaire was primarily developed to evaluate students’ perceived satisfaction with the educational methods used in this study. Content validity was established through expert review; however, exploratory factor analysis and formal construct validation procedures were not performed.

State anxiety inventory

The Turkish validity and reliability of the inventory developed by Spielberger et al. in 1970 was performed by Öner and Le Compte in 1983 (Öner, 1983; Spielberger, 1970). The inventory has 20 items, and the scores range from 20 to 80. An increase in the scores obtained from the inventory indicates an increase in the level of anxiety, and a decrease in the scores suggests a reduction in the level of anxiety. State Anxiety Inventory Cronbach’s alpha values are between 0.94 and 0.96 (Spielberger, 1970). In this study, Cronbach’s alpha values range from 0,89 to 0,92.

Training videos

Three training videos were prepared for the experimental group, covering skills for taking blood from the central venous catheter, administering drugs, and providing care. These videos were organised to cover different stages of central venous catheter care and lasted 10 min in total. The primary purpose of the training videos is to help students consolidate their theoretical knowledge and improve their skills by seeing step-by-step process steps before proceeding to practical applications. Each video contains detailed steps in the Central Venous Catheter Care Skills Assessment Form and shows how to perform each step correctly. In the videos, all steps related to blood collection, drug administration, and dressing care were performed clearly and understandably by the procedure steps. This allows students to learn each step accurately and improve their practice.

The content and structure of the videos were presented to 10 experts to evaluate whether the steps in the form were handled correctly. The videos were finalized by making the necessary arrangements in line with the feedback received from the experts. Thus, the content of the videos was meticulously prepared to support students to learn central venous catheter care skills step by step and to apply them in the most accurate way in practice. The videos were used as reference material during the students’ applications in the experimental group in the laboratory environment. They became an important support tool in the realization of these applications.

Data collection

The data were collected in the spring semester of the 2023–2024 academic year from first-year students in the Faculty of Nursing’s Principles of Nursing course.

Phase one

All students were informed in detail about the purpose and procedures of the study, and written informed consent was obtained from those who agreed to participate. Participants completed the “Personal Information Form” under classroom observation. Subsequently, all students received four hours of theoretical instruction on blood collection, drug administration, and dressing care related to central venous catheters within the Fundamentals of Nursing course. Following the theoretical session, all procedures were demonstrated step by step during a two-hour laboratory practice session. After the training, the “Central Venous Catheter Care Skill Evaluation Form” was administered to all students as a pre-test in the laboratory environment using a skill model.

Phase two

Before the intervention, both groups completed the “State Anxiety Inventory” and the “Training Methods Satisfaction Questionnaire” as baseline assessments. Subsequently, all students performed central venous catheter application procedures on a skill model in the laboratory environment, and baseline psychomotor skill performance was evaluated using an OSCE and the “Central Venous Catheter Care Skill Evaluation Form.”

Phase three

The students in the experimental group were sent training videos on taking blood from the central venous catheter, administering medication, and providing care via text message. It was emphasized that the videos were only for the experimental group and should not be shared with the control group. In addition, it was informed that watching these videos would not affect the exam and achievement scores and that the videos would be sent to the students in the control group after the research was completed. Students were encouraged to watch each video repeatedly to reinforce learning. However, the frequency, duration, and completeness of students’ engagement with the videos could not be objectively monitored. Therefore, the actual level of exposure to the intervention may have varied among participants. Because adherence to the intervention could not be objectively verified, intervention fidelity may have varied across participants. Differences in the frequency and extent of video viewing may have influenced the consistency and magnitude of the educational outcomes observed in the intervention group.

Phase four

One week after the intervention period, both groups completed post-test assessments, including the “State Anxiety Inventory” and the “Training Methods Satisfaction Questionnaire.”

Experimental group

One week after the training videos were sent to the students in the experimental group, they were taken to the laboratory. Before the OSCE exam, students in the intervention group were reminded to review the videos to reinforce learning. All participants were analyzed according to their original group allocation. Students demonstrated blood collection, drug administration, and dressing care procedures for central venous catheters using the skill model during the OSCE assessment. Students’ performances were evaluated using the “Central Venous Catheter Care Skill Evaluation Form.”

Control group

The students in the control group were not shown the training videos. These students demonstrated the skills of taking blood from the central venous catheter, administering drugs, and caring for the model in the laboratory environment. Control group students also completed the OSCE assessment, and their performances were evaluated using the “Central Venous Catheter Care Skill Evaluation Form.”

Data analyses

SPSS 27.0 (Statistical Package for Social Sciences) software was used for data analysis. Descriptive statistics were presented as frequencies and percentages for categorical variables and as mean, standard deviation, minimum, and maximum values for continuous variables. The Shapiro-Wilk test, Skewness, and Kurtosis values were used to evaluate the conformity of the data to a normal distribution. Chi-square (χ²) and Fisher’s Exact tests were applied to compare categorical variables between groups. An independent samples t-test was used for two-group comparisons of continuous variables with a normal distribution, and the Mann-Whitney U test was used for variables without a normal distribution. For within-group pre-test and post-test comparisons, the Dependent Groups t-test was used for normally distributed data, and the Wilcoxon signed-rank test was used for non-normally distributed data. Cronbach’s alpha was calculated to assess the internal consistency of the satisfaction questionnaire. The significance level was set at p < 0.05 for all statistical analyses, and results were assessed using 95% confidence intervals. Because a statistically significant baseline difference was observed in anxiety scores between groups, anxiety-related findings were interpreted cautiously, and both baseline and post-test scores were considered together during interpretation. Analyses were performed based on the power analysis results. Because some variables did not meet the assumptions of normality and the sample size was relatively small, nonparametric analyses were preferred for several comparisons. Although repeated-measures ANOVA or mixed-effects models could provide a more comprehensive evaluation of time-by-group interaction effects, the current analyses were considered appropriate given the data’s distributional characteristics and the exploratory nature of the study. Because the number of internship-group clusters was limited and the primary aim of clustering was contamination prevention rather than hierarchical effect estimation, intracluster correlation coefficients (ICCs) were not calculated, and cluster-adjusted statistical analyses were not performed. Therefore, all analyses were conducted at the individual participant level. Accordingly, the findings should be interpreted as exploratory and should be confirmed in future cluster-adjusted randomized studies.

Limitations

The fact that this study was conducted only with first-year students at a university nursing faculty limits the generalisability of the results. In addition, although cluster allocation was used to minimize contamination, conducting the study within a single academic branch may have introduced selection-related limitations and reduced the sample’s representativeness. In addition, the possibility that students in the intervention and control groups may share information through lectures and social interactions is a significant limitation that may affect the study’s findings. The inability to fully control students’ video-viewing frequency and the possibility that students may be affected by external factors during OSCE preparation further limit the study’s reliability. The frequency, duration, and extent of students’ engagement with the educational videos could not be objectively monitored. Variability in students’ exposure to the intervention may have influenced the effectiveness of the video-assisted training and represents an important limitation affecting intervention fidelity and internal validity. Since adherence monitoring was not available, it was not possible to determine whether all participants received a comparable “dose” of the educational intervention. Some students may have watched the videos repeatedly, whereas others may have had minimal exposure. This uncontrolled variation may have contributed to differences in skill acquisition, anxiety, and satisfaction outcomes within the intervention group. Additionally, the significant baseline difference in anxiety scores between groups may have confounded post-intervention anxiety comparisons. Since adjusted statistical methods such as ANCOVA were not applied, anxiety-related findings should be interpreted cautiously. This limitation may have reduced the precision of between-group comparisons regarding anxiety outcomes. Outcomes were assessed in the short term; long-term skill retention was not evaluated. In addition, analyses were conducted using completed cases only, and intention-to-treat analysis was not performed. Additionally, although content validity was established through expert review and CVI analysis, further psychometric properties of the researcher-developed CVC Skill Assessment Form, including inter-rater reliability and construct validity, were not evaluated. In addition, although the Training Methods Satisfaction Questionnaire demonstrated acceptable internal consistency, comprehensive construct validation analyses such as exploratory factor analysis were not conducted. Future studies should perform more comprehensive psychometric testing of the instrument. In addition, more advanced longitudinal statistical approaches, such as repeated-measures ANOVA or mixed-effects modeling, were not applied. Furthermore, although cluster-based allocation was used, the intracluster correlation was not statistically accounted for in the analysis. Therefore, the assumption of independence between observations may have been partially affected. Future studies with larger samples should consider these methods to more comprehensively evaluate interaction effects between time and group. Additionally, adjusted analytical approaches such as ANCOVA or mixed-effects modeling may provide more precise estimation of intervention effects in future studies. In addition, correction methods for multiple statistical comparisons were not applied. Therefore, the possibility of Type I error should be considered when interpreting statistically significant findings.

Ethical principles of research

This study received ethical approval from the Iğdır University Faculty of Medicine Ethics Committee (Approval date: 24/04/2024; Approval number: 2024-8/2). Written informed consent was obtained from all participants. Although ethical approval was obtained before participant recruitment, trial registration was completed retrospectively. The study was registered retrospectively due to administrative delay in trial registration procedures. In addition, the legal procedures of the research were completed by obtaining written permission from the university where the research would be conducted. Informed consent was obtained from all study participants, and detailed information was given about the research’s aims and processes. It was clearly stated to the students that the research was conducted only for scientific purposes and would not affect their exam results or academic success. This was emphasized to encourage the students’ voluntary participation and relieve their anxiety.

Necessary measures were taken to minimize the interaction between the students in the intervention and control groups, and the students in the experimental group were informed that the training videos given to them would also be sent to the students in the control group after the research was completed. This process aimed to ensure that the control group had access to the same information and training materials at the end of the study in line with the Equity Principle.

Findings

The findings from the research data that evaluated the effect of video-assisted instruction on central venous catheter drug administration, blood collection and care skills, anxiety levels, and satisfaction are given below.

The mean age of the students was 19.98 years (SD = 2.48). The majority of the students were women (72.7%). There was no statistically significant difference between the intervention (n = 33) and control (n = 33) groups in terms of demographic characteristics (p > 0.05). These results indicate that the intervention and control groups were comparable in terms of demographic characteristics and baseline technology-related variables. This indicates that the groups are homogenous and comparable (Table 1).

Table 1.

Comparison of demographic information and technology use characteristics of intervention and control group students

Questions		Total n = 66 n(%)	Intervention n = 33 n(%)	Control n = 33 n(%)	p
Age (Mean ± SD)a	Mean ± SD	19.98 ± 2.48	20.33 ± 3.33	19.63 ± 1.08	0.309b
	Min - Max	18–38	18–38	18–22
Gender	Woman	48(72.7%)	23(69.7%)	25(75.8%)	0.782c
	Male	18(27.3%)	10(30.3%)	8(24.2%)
Coming to the department voluntarily	Yes	39(59.1%)	21(63.6%)	18(54.5%)	0.617c
	No	27(40.9%)	12(36.4%)	15(45.5%)
Feeling Belonging to the Profession	Yes	49(74.2%)	24(72.7%)	25(75.8%)	1.000c
	No	17(25.8%)	9(27.3%)	8(24.2%)
Most frequently accessed content on digital media	Social Media	49(74.2%)	26(78.8%)	23(69.7%)	0.875d
	Education Content	6(9.1%)	3(9.1%)	3(9.1%)
	Shopping	1(1.5%)	0(0.0%)	1(3.0%)
	The Game	2(3.0%)	1(3.0%)	1(3.0%)
	Video Platforms	8(12.1%)	3(9.1%)	5(15.2%)
Purpose of using social media	Getting Information	8(12.1%)	5(15.2%)	3(9.1%)	0.624d
	Making Contact	12(18.2%)	4(12.1%)	8(24.2%)
	Having fun	38(57.6%)	20(60.6%)	18(54.5%)
	Hobbies and Interests	8(12.1%)	4(12.1%)	4(12.1%)
The effect of internet and social media use on learning	Yes	61(92.4%)	31(93.9%)	30(90.9%)	1.000d
	No	5(7.6%)	2(6.1%)	3(9.1%)
Use of video in trainings	Yes	46(69.7%)	22(66.7%)	24(72.7%)	0.789c
	No	20(30.3%)	11(33.3%)	9(27.3%)
Reduced learning anxiety when watching videos in trainings	Yes	47(71.2%)	21(63.6%)	26(78.8%)	0.277d
	No	19(28.8%)	12(36.4%)	7(21.2%)
Satisfaction while watching videos in trainings	Yes	60(90.9%)	29(87.9%)	31(93.9%)	0.672d
	No	6(9.1%)	4(12.1%)	2(6.1%)

^aNon-Normally Distributed Data

^b Mann-Whitney U Test

^c Chi-Square (with Continuity Correction)

^d Fisher’s Exact Test

When the students’ pre-application test results were examined, no statistically significant difference was found between the groups in total skill score (U = 518.000, Z=-0.344, p = 0.731), blood collection (U = 526.500, Z=-0.243, p = 0.808), drug administration (U = 542.500, Z=-0.027, p = 0.978), and dressing (U = 486.000, Z=-0.838, p = 0.402) skills. These results show that both groups had similar skill levels at the beginning of the study.

The post-test results showed statistically significant differences for the intervention group in all skill areas. The effect sizes observed for psychomotor skill outcomes were large (r ranging between 0.787 and 0.815), indicating that the intervention was associated with statistically significant improvements and potentially meaningful educational effects on students’ skill performance. Effect size interpretations were based on the magnitude of the absolute values rather than on the direction of the coefficients. Total skill score (U = 43.500, Z=-6.440, p < 0.001, r=-0.793), blood collection (U = 32.500, Z=-6.622, p < 0.001, r=-0.815), drug administration (U = 50.500, Z=-6.393, p < 0.001, r=-0.787) and dressing (U = 48.500, Z=-6.527, p < 0.001, r=-0.804) skills, the intervention group obtained significantly higher scores than the control group.

In intragroup comparisons, the intervention group showed a large, statistically significant effect size between pre- and post-test scores across all skill areas (p < 0.001, r > 0.8 in all areas). These large effect sizes suggest that video-assisted instruction may have contributed to psychomotor skill acquisition beyond that achieved through routine laboratory-based education alone. In the control group, statistically significant but minor effect-size improvements were observed in total skill score (Z = -2.384, p = 0.017, r = -0.415) and drug administration (Z = -2.410, p = 0.016, r = -0.419) skills. In contrast, no significant change was observed in blood collection (Z = -1.625, p = 0.104) or dressing (Z = -0.378, p = 0.705) skills. These results suggest that the intervention group demonstrated greater improvements in skill areas, whereas the control group showed more limited improvement. Video-assisted instruction was associated with greater improvements than the traditional method in improving drug administration, blood collection, and dressing care skills related to central venous catheters within the scope of this study. The increase in practical examination scores observed in the intervention group suggests that video-assisted instruction may support the acquisition of practical skills (Table 2).

Table 2.

Comparison of practice examination scores of intervention and control group students

Tests Between Groups		Intervention n = 33	Control n = 33	Between Groups Test Value
Total Skill Pre-Test Scoreab	Mean ± SD	23.93 ± 7.04	23.27 ± 5.33	U = 518.000 Z=-0.344 p = 0.731 r=-0.042
	Min - Max	10–54	12–38
Total Skill Post-test Scoreab	Mean ± SD	74.06 ± 16.04	25.69 ± 11.53	U = 43.500 Z=-6.440 p < 0.001 r=-0.793
	Min - Max	22–98	14–84
In-Group Test Valueac	Pre-Test–Post-Test	Z=-4.939 p < 0.001 r=-0.860	Z=-2.384 p = 0.017 r=-0.415
Blood Collection Pre-Test Scoreab	Mean ± SD	8.60 ± 2.66	8.48 ± 2.78	U = 526.500 Z=-0.243 p = 0.808 r=-0.030
	Min - Max	4–16	2–18
Blood Collection Post-Test Scoreab	Mean ± SD	26.96 ± 6.06	9.27 ± 4.38	U = 32.500 Z=-6.622 p < 0.001 r=-0.815
	Min - Max	10–36	4–30
Intragroup Blood Collection Test Valueac	Pre-Test–Post-Test	Z=-4.948 p < 0.001 r=-0.861	Z=-1.625 p = 0.104 r=-0.283
Drug Administration Pre-Test Scoreab	Mean ± SD	7.15 ± 2.55	7.15 ± 2.12	U = 542.500 Z=-0.027 p = 0.978 r=-0.003
	Min - Max	4–18	4–12
Drug Administration Post-Test Scoreab	Mean ± SD	22.54 ± 5.13	8.30 ± 3.97	U = 50.500 Z=-6.393 p < 0.001 r=-0.787
	Min - Max	6–30	4–26
In-Group Drug Administration Test Valueac	Pre-Test–Post-Test	Z=-4.946 p < 0.001 r=-0.861	Z=-2.410 p = 0.016 r=-0.419
Dressing Pre-Test Scoreab	Mean ± SD	8.18 ± 3.05	7.63 ± 1.45	U = 486.000 Z=-0.838 p = 0.402 r=-0.103
	Min - Max	0–20	4–10
Dressing Post-Test Scoreab	Mean ± SD	24.54 ± 6.31	8.12 ± 3.87	U = 48.500 Z=-6.527 p < 0.001 r=-0.804
	Min - Max	6–34	4–28
In-Group Dressing Test Valueac	Pre-Test–Post-Test	Z=-4.944 p < 0.001 r=-0.861	Z=-0.378 p = 0.705 r=-0.066

^aNon-Normally Distributed Data

^b Mann-Whitney U Test

^c Wilcoxon Signed-Rank Test

r = effect size coefficient for non-parametric tests. Negative values indicate the direction of change or group difference and should not be interpreted as negative clinical effects

Table 3 compares the students’ State Anxiety Scale scores in the intervention and control groups. In the beginning, the anxiety level of the control group (48.87 ± 7.56) was significantly higher than the intervention group (44.39 ± 8.71) (p = 0.029). After the intervention, no significant difference was found between the groups in terms of anxiety level (p = 0.222), indicating that the anxiety levels between the groups approached each other after the intervention. In addition, the observed effect size for post-test anxiety scores was small (d = 0.304), suggesting a limited practical impact of the intervention on anxiety reduction. In intragroup analyses, no significant change was observed in the anxiety level in the intervention group, while a significant decrease was found in the anxiety level in the control group (p = 0.023). These findings should be interpreted cautiously because the control group demonstrated significantly higher baseline anxiety scores before the intervention. Because adjusted statistical approaches such as ANCOVA were not applied, the independent effect of the intervention on anxiety outcomes could not be isolated from baseline group differences. Therefore, the post-intervention anxiety findings may have been influenced by initial between-group differences rather than solely by the educational intervention. Video-assisted instruction did not demonstrate a statistically significant anxiety-reducing effect in this study. In addition, anxiety scores in the intervention group showed a slight numerical increase following the intervention, although this change was not statistically significant.

Table 3.

Comparison of State Anxiety Scale Scores of Intervention and Control Group Students

Tests Between Groups		Intervention n = 33	Control n = 33	Between Groups Test Value
State Anxiety Pre-testa	Mean ± SD	44.39 ± 8.71	48.87 ± 7.56	t=-2.234 p = 0.029 d=-0.550
	Min - Max	26–63	32–65
State Anxiety Post-testa	Mean ± SD	46.36 ± 6.64	44.18 ± 7.67	t = 1.234 p = 0.222 d = 0.304
	Min - Max	34–58	27–56
In-Group Test Valueb	Pre-Test–Post-Test	t=-0.983 p = 0.333 r=-0.108 d=-0.171	t = 2.392 p = 0.023 r=-0.095 d = 0.416

^a Independent Sample T-Test

^b Paired Samples T-Test

d = Cohen’s d effect size. Negative values indicate the direction of the difference between groups or measurements

Table 4 compares the satisfaction questionnaire scores of the students in the intervention and control groups. In the pre-test, the mean satisfaction score in the intervention group was 56.30 ± 12.17, and in the control group it was 57.81 ± 10.40; no significant difference was found between the two groups (t = -0.543, p = 0.589). In the post-test, the intervention group mean was 59.57 ± 12.74, and the control group mean was 57.93 ± 15.32; again, no significant difference was found between the groups (t = 0.472, p = 0.639). The small effect size observed for satisfaction outcomes (d = 0.14) also indicates that the intervention had minimal practical influence on students’ satisfaction levels. In intragroup analyses, no significant change was observed in the pre-test and post-test scores of both the intervention and control groups (intervention: p = 0.299; control: p = 0.972). These findings indicate that video-assisted instruction and the traditional method had similar effects on students’ satisfaction levels.

Table 4.

Comparison of Satisfaction Scores of Control and Intervention Group Students (n = 66)

Tests Between Groups		Intervention n = 33	Control n = 33	Between Groups Test Value
Satisfaction Survey Pre-Test Total Scorea	Mean ± SD	56.30 ± 12.17	57.81 ± 10.40		t=-0.543 p = 0.589 d=-0.134 α = 0.95c
	Min - Max	35–80	41–80
Satisfaction Survey Post-Test Total Scorea	Mean ± SD	59.57 ± 12.74	57.93 ± 15.32		t = 0.472 p = 0.639 d = 0.14 α = 0.97c
	Min - Max	39–80	24–80
In-Group Test Valueb	Pre-Test–Post-Test	t=-1.056 p = 0.299 r=-0.020 d=-0.184	t=-0.035 p = 0.972 r=-0.134 d=-0.006

The flow diagram also shows participant withdrawals, losses to follow-up, and the final numbers included in the per-protocol analyses

^a Independent Sample T-Test

^b Paired Samples T-Test

^c Cronbach’s Alpha

d = Cohen’s d effect size. Negative values indicate the direction of the observed difference and do not represent adverse effects

Discussion

This study observed that students receiving video-assisted instruction demonstrated higher psychomotor skill performance, especially in skills such as blood sampling, drug administration, and dressing care from the central venous catheter. This finding is consistent with the literature suggesting that video-based learning may enhance nursing students’ psychomotor skills [16, 25]. Instructional videos alone may contribute to the development of practical knowledge [26]. Video-based training may positively influence learners’ engagement and procedural understanding [27]. The studies by Burton (2022) and Bahar et al. (2017) stated that video training enables students to watch the procedural steps repeatedly, ensuring knowledge retention and mastery of complex skills [25, 28]. Furthermore, the increase in skill scores in the intervention group in this study suggests that visual teaching methods are particularly beneficial in technical tasks requiring sequential comprehension and motor precision [29, 30]. Burton (2022) stated that video resources such as YouTube are effective in reducing anxiety in nursing education, primarily by increasing familiarity with invasive procedures. Kiliç and Cevheroğlu (2023) on central venous catheter care training also revealed that video-based training was associated with improved psychomotor skill outcomes, consistent with the findings of the present study [31]. Bahar et al. (2017) also observed that integrating videos was influential in developing parenteral drug administration skills. Similarly, Clerkin et al. (2022) reported that video-based learning allows students to review at their own pace, thereby increasing their confidence and competence in clinical practice. The systematic review by Clerkin et al. (2022) also confirms the value of video resources in nursing education, particularly for repetitive learning and reducing dependence on face-to-face demonstrations. The skill development observed in the intervention group suggests that video-assisted learning may be a useful learning tool, especially for students who benefit from its visual and repetitive nature [32]. Nevertheless, students’ actual engagement with the videos was not objectively monitored. Therefore, it remains unclear whether all participants received comparable exposure to the intervention. These findings suggest that video-assisted instruction may support procedural preparedness and clinical skill development related to central venous catheter care among first-year nursing students. Nevertheless, the findings should be interpreted within the methodological limitations of the study, including an imbalance in baseline anxiety, limited monitoring of intervention fidelity, and limited psychometric evaluation of the researcher-developed instruments. These factors may influence the strength and generalisability of the conclusions. The large effect sizes observed for psychomotor skill outcomes suggest potential practical significance and indicate that video-assisted instruction may provide educational benefits in clinical skill acquisition. Nevertheless, because the psychometric evaluation of the researcher-developed skill assessment form was primarily limited to content validity procedures, the findings regarding psychomotor skill performance should be interpreted within this methodological context.

In this study, anxiety levels decreased significantly in the control group, whereas anxiety levels remained relatively stable in the intervention group. Burton (2022) reported that nursing students’ access to YouTube videos while learning IV skills did not significantly reduce anxiety [28]. Similarly, Baksi et al. (2020) observed that students’ anxiety persisted while learning psychomotor skills [33]. These findings indicate that evidence supporting an anxiety-reducing benefit of video-assisted instruction was not demonstrated under the conditions of the present study. Therefore, the present findings should not be interpreted as definitive evidence that video-assisted instruction is ineffective for anxiety reduction. However, some studies in the literature have reported that training videos have anxiety-relieving effects. For example, Bahar et al. (2017) found that video-assisted education was reported to be associated with reduced anxiety and improved parenteral drug administration skills [25]. Özdemir et al. (2023) also suggested that video-assisted instruction was associated with reduced student anxiety [34]. Similar findings were obtained in the studies conducted by Cardoso et al. (2012) and Haddad et al. (2018) [31, 35]. However, the fact that the anxiety levels observed in our study did not change suggests that the nature of clinical practice may play a role as a stress factor for students. Mahfouz and Alsahli (2016) and Rathnayake and Ekanayaka (2016) emphasized that the stress encountered during nursing education is an essential factor affecting students’ anxiety levels [36, 37]. In conclusion, although educational videos may contribute to procedural familiarity and learning support, the present findings do not provide strong evidence for a clear anxiety-reducing effect. Video exposure alone may improve procedural familiarity but may be insufficient to address performance-related stress during OSCE settings, which often requires guided practice, feedback, and simulation-based exposure. Future studies using cluster-adjusted analyses and objective monitoring of intervention adherence are needed to strengthen the evidence base regarding video-assisted instruction in psychomotor nursing education.

In this study, video-assisted instruction and traditional instruction yielded similar results in students’ satisfaction levels. In the literature, video-assisted instruction has been shown to increase student satisfaction. Lee et al. (2016) found that video-assisted instruction was associated with higher student satisfaction; providing students with unlimited access to videos positively affected their satisfaction by allowing them to practice and repeat skills [38, 39]. Forbes et al. (2016) emphasize that blending video-supported education with theoretical presentations supports students’ access to knowledge and practical skills [14]. Çiftçi et al. (2023) reported that the ability of nursing students to access information through videos and manage the learning process according to their own pace provided a high level of satisfaction and that they demanded more videos [40]. Özdemir and Kesgin Güngör (2023) also show that video-assisted education makes students feel more comfortable while learning practical skills [34]. Chuang et al. (2018) pointed out that video-supported education increased student skills and self-confidence; Sowan and Idhail (2014) found that video-supported web-based education was associated with increased student satisfaction [8, 41]. Mete and Uysal (2010) and (Wolf and Peyre 2018) observed the positive effects of video-assisted instruction on student satisfaction in psychomotor skills training [42, 43]. However, no statistically significant difference was observed between the video-assisted instruction and traditional teaching groups regarding student satisfaction outcomes [42, 43]. These findings suggest that both instructional approaches were associated with comparable satisfaction levels in the present study; however, formal equivalence testing was not conducted. Satisfaction scores were relatively high at baseline in both groups, suggesting a potential ceiling effect that may have limited the ability to detect between-group differences.

Clinical relevance

In the present study, video-assisted teaching was associated with improved psychomotor skill performance related to central venous catheter care among first-year nursing students. This method may support students’ preparation for clinical procedures and psychomotor skill development during simulated clinical training environments. Video-based learning, particularly when combined with simulation and guided practice, may help students feel more prepared and supported during clinical skill training; however, its independent effect on anxiety reduction remains uncertain. Future studies are needed to determine whether these short-term improvements in psychomotor performance translate into enhanced clinical practice outcomes or patient care quality. Although these findings may have implications for clinical education practices, the present study did not directly evaluate clinical performance or patient outcomes. In addition, the findings should be interpreted cautiously because cluster-adjusted analyses were not performed and intervention fidelity could not be fully monitored. Future multicenter randomized studies with larger cluster sizes are recommended to improve the external validity of the findings.

Conclusion and recommendations

The findings of this study suggest that video-assisted teaching may improve short-term psychomotor skill performance in central venous catheter care among first-year nursing students in a simulated laboratory setting. However, its effects on anxiety reduction and student satisfaction remain inconclusive, and no statistically significant differences were identified between groups in satisfaction outcomes. Rapid access to information through video-assisted instruction within simulated educational settings may support psychomotor skill acquisition and procedural preparation.

However, the present findings did not demonstrate a clear beneficial effect of video-assisted instruction on anxiety reduction or on student satisfaction. In this context, combining video-assisted education with other supportive methods may increase the likelihood of reducing anxiety and enabling students to achieve higher levels of satisfaction with the educational process. Therefore, integrating video-assisted educational tools into psychomotor skill training may be considered a supportive instructional strategy in similar educational settings. Future studies should further investigate the long-term emotional and educational effects of video-assisted learning in nursing education. At the same time, additional strategies should be developed to address students’ emotional needs.

It is suggested that video-assisted education should be combined with methods such as simulation and guided practices to increase the effect of reducing anxiety. Guidance and psychological support should be provided to address students’ emotional needs, helping them feel more comfortable learning. In addition, institutions’ technological infrastructure should be strengthened to facilitate access to video materials. Further research examining the long-term effects of video-assisted instruction will also help us understand the lasting contributions of this method. Nevertheless, the findings of this study should be interpreted within several methodological limitations, including the single-center design, short-term follow-up period, inability to objectively monitor students’ video exposure, baseline imbalance in anxiety scores between groups, and the potential for contamination through student interaction despite preventive measures. These factors may have influenced the precision and generalisability of the findings.

Authors’ contributions

All listed authors meet the authorship criteria and that all authors agree with the content of the manuscript.

Funding

The authors received no financial support for this article’s research, authorship, and publication.

Data availability

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

Declarations

Ethics approval and consent to participate

This study received ethical approval from the Iğdır University Faculty of Medicine Ethics Committee (Approval date: 24/04/2024; Approval number: 2024-8/2). Written informed consent was obtained from all participants. The study was conducted in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable. No identifying images or other personal or clinical details of participants are presented in this manuscript.

Competing interests

The authors declare no competing interests.