Problem-Based Learning to Improve Critical Thinking in Obstetric Nursing Students

Enhancing Critical Thinking, Clinical Decision-Making, and Knowledge Retention Utilizing Problem-Based Learning: A Cluster Randomized Controlled Trial Among Obstetric Nursing Students

This study examined the effect of a problem-based learning (PBL) instructional approach on undergraduate nursing students' learning outcomes in obstetrics health nursing. The intervention was implemented with nursing students at the Faculty of Nursing, Benha University, Egypt.

Students participated in structured problem-based learning sessions designed to enhance critical thinking, clinical decision making, and knowledge retention related to maternal and newborn health topics. Learning outcomes were assessed before and after the intervention using validated assessment tools.

The findings of this study aim to provide evidence on the effectiveness of problem-based learning as an educational strategy in nursing education and to inform curriculum development and teaching practices in obstetrics health nursing Course.

Study Overview

• Status: Completed
• Conditions: Problem-based Learning in Nursing Education
• Intervention / Treatment: Behavioral: Problem-Based Learning (PBL); Behavioral: Traditional Lecture-Based Instruction

Detailed Description

This study is a cluster randomized controlled trial designed to evaluate the effect of a problem-based learning (PBL) instructional approach on critical thinking, clinical decision-making, and knowledge acquisition and retention among undergraduate obstetric nursing students. The study was conducted in classroom settings at the Faculty of Nursing, Benha University, Benha, Egypt, during the first semester of the 2025-2026 academic year.

Eligible participants were third-level undergraduate nursing students enrolled in the obstetrics nursing course. Academic groups were used as the unit of randomization to minimize contamination between students. From the available academic groups, 12 clusters were randomly selected and allocated in a 1:1 ratio to either the intervention group (PBL) or the control group (traditional lecture-based instruction). All eligible students within the selected clusters were included, resulting in a total sample of 312 students.

At baseline, participants in both groups completed assessments measuring demographic characteristics, knowledge acquisition, critical thinking, and clinical decision-making. Following baseline assessment, control clusters received traditional lecture-based instruction covering normal labor, preeclampsia/eclampsia, and postpartum hemorrhage according to the standard course syllabus. Intervention clusters participated in a structured PBL program addressing the same topics using standardized clinical case scenarios and guided facilitation. The intervention emphasized problem identification, self-directed learning, group discussion, and application of knowledge to clinical decision-making.

Outcome measures were collected immediately after completion of the instructional period and again four weeks later to evaluate knowledge retention and sustained development of critical thinking and clinical decision-making skills. Validated instruments were used to assess critical thinking and clinical decision-making, while a researcher-developed, case-based multiple-choice questionnaire was used to assess knowledge acquisition and retention. Ethical approval was obtained from the Scientific Research Ethics Committee of the Faculty of Nursing, Helwan University prior to study initiation. Participation was voluntary, and informed consent was obtained from all participants.

• Study Type: Interventional
• Enrollment (Actual): 312
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Qalyubia Governorate
    • Banhā, Qalyubia Governorate, Egypt
      • Faculty of Nursing, Benha University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Undergraduate nursing students enrolled in the third academic level of the Obstetrics and Gynecology Nursing course at the Faculty of Nursing, Benha University.
2. Aged 18 to 21 years at the time of enrollment.
3. Regular attendance in the course during the study period.
4. Willingness to participate and provide written informed consent.
5. No prior formal exposure to structured problem-based learning (PBL).
6. Completion of baseline assessment prior to participation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Problem-Based Learning (PBL) Group; Participants in this arm received a structured problem-based learning (PBL) instructional program covering normal labor, preeclampsia/eclampsia, and postpartum hemorrhage. The intervention was delivered in small-group sessions using standardized clinical case scenarios, guided facilitation, self-directed learning, and group discussion over a six-week period.	Behavioral: Problem-Based Learning (PBL); A structured problem-based learning instructional approach using standardized clinical case scenarios related to maternal and newborn health nursing. The intervention emphasized active learning, small-group discussion, self-directed learning, clinical reasoning, and facilitated synthesis of evidence-based nursing decisions. Arm Assigned:Problem-Based Learning (PBL) Group
Active Comparator: Traditional Lecture-Based Instruction Group; Participants in this arm received traditional lecture-based instruction covering normal labor, preeclampsia/eclampsia, and postpartum hemorrhage, delivered through instructor-led lectures and PowerPoint presentations in accordance with the standard course syllabus.	Behavioral: Traditional Lecture-Based Instruction; Traditional lecture-based instruction delivered through instructor-led teaching and PowerPoint presentations, covering maternal and newborn health nursing topics according to the standard undergraduate nursing curriculum. Arm Assigned:Traditional Lecture-Based Instruction Group

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Critical Thinking Skills	Critical thinking skills were assessed using the Critical Thinking Questionnaire (CThQ), a validated 25-item self-administered instrument measuring six domains of critical thinking: remembering, understanding, applying, analyzing, evaluating, and creating. Items are rated on a 5-point Likert scale, with higher scores indicating stronger critical thinking ability.	Baseline (pre-intervention), immediately post-intervention, and 4-week follow-up
Clinical Decision-Making Ability	Clinical decision-making ability was measured using the Clinical Decision Making in Nursing Scale (CDMNS), a validated 40-item self-report instrument assessing four dimensions of decision-making: search for alternatives, canvassing of objectives and values, evaluation of consequences, and information search. Higher total scores reflect more developed clinical decision-making abilities.	Baseline (pre-intervention), immediately post-intervention, and 4-week follow-up
Knowledge retention in obstetrics Health Nursing	Knowledge acquisition and retention were assessed using a researcher-developed, case-based multiple-choice questionnaire covering normal labor, preeclampsia/eclampsia, and postpartum hemorrhage. The tool consists of 30 items, with higher scores indicating higher levels of knowledge acquisition and retention.	Baseline (pre-intervention), immediately post-intervention, and 4-week follow-up

Collaborators and Investigators

• Sponsor: Eman Atef Elsokary
• Collaborators: Helwan University
• Investigators: Principal Investigator: Eman Atef Elsokary, PhD, Faculty of Nursing, Helwan University, Egypt

Study record dates

Study Major Dates

• Study Start (Actual): September 20, 2025
• Primary Completion (Actual): December 25, 2025
• Study Completion (Actual): January 20, 2026

Study Registration Dates

• First Submitted: January 21, 2026
• First Submitted That Met QC Criteria: January 21, 2026
• First Posted (Actual): January 28, 2026

Study Record Updates

• Last Update Posted (Actual): January 28, 2026
• Last Update Submitted That Met QC Criteria: January 21, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Cluster randomized trial; Problem-based learning; Educational intervention; Nursing education; Critical thinking; Clinical decision making; Obstetric nursing; Knowledge retention; Undergraduate nursing students
• Other Study ID Numbers: PBL-OBN-2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No