THE EFFECT OF DIGITAL STORYTELLING ON NURSING STUDENTS' NURSING PROCESS EDUCATION

THE EFFECT OF DIGITAL STORYTELLING ON NURSING STUDENTS' NURSING PROCESS EDUCATION: AN EXPERIMENTAL STUDY

Study Type: Randomized Controlled Experimental Study

Purpose:

This study aims to evaluate the effects of digital storytelling-enhanced nursing process education on nursing students' knowledge, nursing process competency, and clinical reasoning skills. The nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation, forms the foundation of evidence-based and holistic care. However, the literature indicates that nursing students often face difficulties in assessment, prioritization, and individualization of care interventions and frequently apply the process mechanically.

The study addresses the following primary questions:

Does digital storytelling improve nursing students' knowledge of the nursing process?

Does digital storytelling enhance students' nursing process competency and clinical reasoning skills?

Study Design and Comparison:

Participants will be assigned to either the intervention or control group based on their Nursing Process knowledge scores. Groups will be stratified by gender and knowledge test scores using a stratified randomization method to ensure balanced distribution and group homogeneity. Researchers will compare outcomes between groups to evaluate the effectiveness of the educational approach.

Participants' Key Activities:

Participants must be first-time enrollees in the Fundamentals of Nursing I course, have completed all course content, and have voluntarily agreed to attend.

Complete pre- and post-intervention assessments, including the Nursing Process Knowledge Test, Nursing Process Competency Scale, Clinical Reasoning Assessment Rubric, and Instructional Material Motivation Scales.

Engage in follow-up evaluations immediately after the intervention and three months later to assess the retention and sustainability of learning outcomes.

Additional Notes:

Digital storytelling materials will be validated through expert review and pilot testing. The Clinical Reasoning Assessment Rubric will undergo Turkish-language validity and reliability evaluation. Findings are expected to provide evidence on the effectiveness of digital storytelling in nursing process education, support curriculum development at the undergraduate level, and guide the broader implementation of technology-enhanced, reflective learning approaches in nursing education.

Study Overview

• Status: Not yet recruiting
• Conditions: Education, Nursing; Clinical Competence; Evidence-Based Practice; Students, Nursing; Clinical Decision-Making in Nursing
• Intervention / Treatment: Other: Intervention Description - Digital Storytelling Group; Other: Control Group (Traditional Case-Based Education)

• Study Type: Interventional
• Enrollment (Estimated): 104
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Esin Kelagalar, MSc; Phone Number: +90 5418972303; Email: esinkelagalar@gmail.com
• Study Contact Backup: Name: Özlem Doğu, Associate Professor; Phone Number: +90 505 679 20 63; Email: ozlemdogu@sakarya.edu.tr

Study Locations

• Turkey (Türkiye)
  • Sakarya, Turkey (Türkiye), 54100
    • Sakarya University
    • Contact: Dilek Aygin, Professor; Phone Number: +90 532 707 63 14
    • Principal Investigator: Esin Kelagalar, MSc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Undergraduate nursing students enrolled in the Nursing Fundamentals I course for the first time
• Students who attend and complete all educational activities related to the course
• Students who voluntarily agree to participate in the study

Exclusion Criteria:

• Graduates of a health vocational high school
• Students who report prior knowledge or formal education related to the nursing process
• Students who are currently employed in any healthcare institution

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Digital Storytelling Based Nursing Process Education; Participants in the intervention group will receive nursing process education supported by digital storytelling within the Nursing Fundamentals I course. A digital story developed by the research team will present a single clinical scenario illustrating the stages of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation. Students will watch the digital story and participate in guided discussions to analyze the presented clinical situation and apply the nursing process in a structured manner. The digital storytelling approach is intended to promote reflective learning, contextual understanding of the patient situation, and the development of clinical reasoning skills. Assessments will be conducted before the intervention, immediately after the educational sessions, and three months later to evaluate nursing process knowledge, competency, and clinical reasoning outcomes.

Other: Intervention Description - Digital Storytelling Group; Participants assigned to the intervention group will receive nursing process education supported by digital storytelling within the Nursing Fundamentals I course. A digital story developed by the research team will present a single clinical scenario illustrating the stages of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation. Students will watch the digital story, participate in guided discussions, and analyze the presented scenario to apply the nursing process in a structured manner. This approach aims to promote reflective learning, contextual understanding of the patient situation, and the development of clinical reasoning skills. Educational activities will be conducted during scheduled course sessions as part of the nursing process training.; Other: Control Group (Traditional Case-Based Education); Participants in the control group will receive traditional nursing process education within the Nursing Fundamentals I course. Teaching will be conducted using a written clinical case representing the same patient situation used in the intervention group. Students will analyze the case and apply the steps of the nursing process, including assessment, diagnosis, planning, implementation, and evaluation, through instructor-led explanations and classroom discussion. This approach reflects the conventional educational method used in the course. Outcome assessments will be conducted at the same time points as the intervention group, including before the intervention, immediately after the educational sessions, and three months later, in order to evaluate nursing process knowledge, competency, and clinical reasoning skills.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nursing Process Knowledge	Change in nursing students' knowledge of the nursing process measured using the Nursing Process Knowledge Test.The student knowledge test consists of 25 multiple-choice questions designed to assess knowledge related to the nursing process. Each correct answer is scored as 4 points and incorrect answers receive 0 points, resulting in a total possible score ranging from 0 to 100. Higher scores indicate a higher level of knowledge. It is expected that students who participate in the digital storytelling-based educational intervention will demonstrate an increase in knowledge scores compared with their baseline scores.	Baseline pre-intervention, immediately after the educational intervention, and 3 months after the intervention.
Nursing Process Competency Scale	The Nursing Process Competency Scale (NPCS) is a 24-item instrument comprising five subscales: Data Collection (items 1-4), Patient Problem/Nursing Diagnosis (items 5-9), Planning (items 10-14), Implementation (items 15-21), and Evaluation (items 22-24). Responses are recorded on a five-point Likert scale (1 = I do not trust myself at all, 2 = I do not trust myself, 3 = I feel I need more practice, 4 = I trust myself, 5 = I feel competent in this skill), with no cut-off points or reverse-scored items. Subscale scores are calculated by dividing the total score by the number of items, resulting in mean scores ranging from 1 to 5, where higher scores indicate greater competency in the nursing process.	Baseline pre-intervention, immediately after the educational intervention, and 3 months after the intervention.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Reasoning Skills	Change in students' clinical reasoning skills evaluated using the Clinical Reasoning Assessment Rubric applied to the nursing process case analysis. The Clinical Reasoning Rubric is an assessment tool developed to evaluate students' clinical reasoning skills. The rubric is structured into eight categories based on the five stages of the nursing process. Content and face validity of the rubric were established qualitatively, resulting in a clear and practical set of criteria for evaluating clinical reasoning performance. The rubric is used to systematically assess students' clinical reasoning during the nursing process.	Baseline pre-intervention, immediately after the educational intervention, and 3 months after the intervention.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Instructional Material Motivation	Students' motivation regarding the instructional material will be evaluated using the Instructional Materials Motivation Scale (IMMS). This scale is a unidimensional 14-item instrument with no reverse-scored items and is specifically designed to measure users' motivation in relation to a single instructional material or application. Higher total or mean scores reflect a greater degree of positive motivation toward the evaluated material.	Immediately after completion of the educational intervention.

Collaborators and Investigators

• Sponsor: Sakarya University

Study record dates

Study Major Dates

• Study Start (Estimated): October 30, 2026
• Primary Completion (Estimated): December 30, 2026
• Study Completion (Estimated): January 30, 2027

Study Registration Dates

• First Submitted: March 8, 2026
• First Submitted That Met QC Criteria: March 8, 2026
• First Posted (Actual): March 12, 2026

Study Record Updates

• Last Update Posted (Actual): March 25, 2026
• Last Update Submitted That Met QC Criteria: March 22, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Digital Storytelling; Educational Intervention; Nursing Education; Clinical Reasoning; Nursing Process; Undergraduate Nursing Students
• Additional Relevant MeSH Terms: Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: SakaryaU-2026-29-87-35; 2026-29-87-35 (Other Grant/Funding Number: Sakarya University)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: The decision regarding sharing individual participant data has not yet been made. This study involves undergraduate nursing students, and the collected data include personal academic information and responses to educational assessments. Data sharing considerations will take into account participant confidentiality, ethical approvals, and institutional policies. A final plan for data sharing may be developed upon completion of the study and in accordance with applicable regulations and guidelines.

Drug and device information, study documents

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