Sequential Case Triangle-Based Learning and Psychosocial Care Competency in Nursing Students

Background: Nursing education aims to develop critical thinking, problem-solving, and clinical reasoning skills, alongside the ability to provide holistic psychosocial care. Case-based and project-based learning are student-centered strategies shown to support these outcomes, but their combined application in a sequential, team-dependent format has not been widely studied in psychosocial nursing education.

Objective: To evaluate the effect of a Sequential Case Triangle-based project-based learning approach, applied within a Psychosocial Nursing course, on nursing students' self-assessed psychosocial care competency, cooperative learning, and clinical reasoning levels.

Hypotheses:

H1: Students' psychosocial care competency self-assessment scores will increase after the intervention.

H2: Students' cooperative learning scores will increase after the intervention. H3: Students' clinical reasoning levels will increase after the intervention.

Design: Single-group, pretest-posttest quasi-experimental design.

Setting: Fourth-year nursing students enrolled in the "Psychosocial Nursing" elective course (Turkish-medium and English-medium sections) at Istanbul Medipol University, Faculty of Health Sciences, Department of Nursing, during the 2025-2026 spring semester.

Intervention: Over the 15-week course, the class was divided into 20 main groups of 9 to 12 students each (179 participants in total), and every main group was split into three subgroups responsible for a sequential stage of the nursing process: case creation (depicting psychosocial responses to illness), psychosocial assessment, and planning/implementing psychosocial nursing interventions. Each subgroup prepared a short role-play video for its stage and submitted it to the course instructor, who forwarded it unedited to the next subgroup. Subgroups had no access to or prior knowledge of the case content created by the preceding subgroup; each stage was developed solely on the basis of the video received, without the ability to view or revise earlier work. In the final stage, the three videos were combined into one case narrative and discussed in class.

Outcomes were assessed using validated self-report instruments, administered face-to-face at baseline (course week 1) and post-intervention (course week 15).

Statistical Analysis: Data were analyzed using SPSS 22.0. Descriptive statistics (mean, SD, median, min-max for quantitative variables; frequency and percentage for categorical variables) were reported. Pretest-posttest comparisons used the paired-samples t-test; group comparisons used the Student's t-test (two groups) or one-way ANOVA with Bonferroni post-hoc test (three or more groups); associations between variables were assessed with Pearson correlation. Significance was set at p<0.05, 95% confidence interval.