Study Title

Spiritual Care Education in Nursing Students: A Comparison of Lecture-Based and Jigsaw (Collaborative Learning) Methods

Why was this study conducted?

In nursing, "holistic care" involves recognizing and supporting not only physical but also emotional and spiritual needs. However, nursing students may not always learn enough about how to apply spiritual care in the clinic. This study was conducted to understand whether two different training methods affect students' perspectives on spiritual care and the frequency of their spiritual care practice.

Who participated in the study?

Fourth-year students studying in the nursing department of a university in Turkey participated. A total of 90 students completed the study:

Lecture-based group: 30 people

Jigsaw group: 31 people

Control group (no training): 29 people

Students were providing patient care in the clinic for approximately 24 hours a week during their internship.

What was done in this study?

Students were divided into three groups using a lottery method.

Spiritual care training was given to the lecture group via presentation in the classroom (2 sessions, each approximately 40-45 minutes).

In the Jigsaw group, the same content was covered in small groups, with students learning by teaching each other (2 sessions, each approximately 40-45 minutes).

The control group did not receive training during the study (they were also given training after the study ended).

Measurements were taken three times:

Before training (pre-test)

15 days after training (post-test)

1 month after training (retention test)

What was measured?

Perception of spirituality and spiritual care

Frequency of spiritual care practice (how often the student has engaged in spiritual care interventions recently)

Nursing care plans prepared by the students (rated out of 100 points)

In the Jigsaw group, students' opinions on the method were also measured (Jigsaw opinion scale)

What were the findings of the study?

Perception of Spiritual Care :

Students who received both direct instruction and Jigsaw training showed increased scores after the training.

The highest increase was observed in the Jigsaw group.

This increase continued after 1 month (persistence).

Frequency of Spiritual Care Practice :

No significant difference was found among the three groups.

In other words, the training did not significantly increase the frequency with which students said they "practiced spiritual care" in the short term.

Care Plan Scores:

There was no significant difference between the groups (although the average of the Jigsaw group appeared higher, there was no statistically significant difference).

Student opinions about Jigsaw:

Approximately 48%-77% of students rated the Jigsaw method as "more effective" in various items.

In open-ended responses, students found aspects such as information sharing, discussion, and participation positive.

What do these findings mean?

This study shows that students' perception of spiritual care can be further developed when it is addressed in the classroom not only through lectures but also through interactive methods. However, "increased perception" may not automatically mean "more frequent clinical practice" in the short term. Practicing spiritual care likely requires a clinical setting, guidance/mentoring, time, and practice.

Safety/Were there any risks?

Since this study was educational, no medical risks/side effects were expected for the participants. Students participated voluntarily and could leave at any time.

Ethical approval and confidentiality

Permission was obtained from the university's ethics committee for the study (09/04/2025 - E.2025/147). Students were informed and provided written consent. Data was kept confidential.

Funding

The study was supported by the Recep Tayyip Erdoğan University Development Foundation (02026002004083).

Conclusion

Both lecture-based and Jigsaw training increased students' perception of spiritual care; Jigsaw had a stronger effect. In contrast, no significant short-term change was observed in the frequency of spiritual care practice. It is recommended that spiritual care training be strengthened with practice-based and longer-term support to facilitate its translation into clinical practice.

This study is a three-arm randomized controlled trial designed to evaluate the effects of two different educational approaches for spiritual care training on final-year undergraduate nursing students. Although spiritual care is widely recognized as a core component of holistic nursing practice, undergraduate nursing education often remains limited in providing structured and practice-oriented learning opportunities that facilitate the translation of spiritual care knowledge into clinical practice. Therefore, this study compares a traditional didactic lecture approach with an interactive, collaborative learning method (Jigsaw technique), using a control group for comparison.

Eligible participants are fourth-year nursing students enrolled at a Faculty of Health Sciences in Türkiye. Fourth-year students were selected because they actively participate in patient care during their internship placements for approximately 24 hours per week, which provides an appropriate context for evaluating both perceptions and practice-related outcomes.

Participants are allocated into three parallel groups using simple randomization: (1) didactic lecture group, (2) Jigsaw technique group, and (3) control group. The educational intervention is delivered in two sessions, each lasting approximately 40-45 minutes, conducted outside regular class hours and scheduled at times convenient for students. Both intervention groups receive the same core content, developed based on current literature and reviewed by experts prior to implementation. The control group receives no training during the study period; however, after completion of data collection, students in the control group are offered lecture-based training to ensure educational fairness.

In the didactic lecture group, the content is delivered through PowerPoint-based presentations in a classroom setting. In the Jigsaw group, students are divided into small groups and learn the same content through structured peer teaching. The content is divided into four subtopics: (1) basic concepts of spirituality and spiritual care and nursing theorists' perspectives; (2) spiritual care within the nursing process and nursing diagnoses related to spiritual care; (3) spiritual care interventions; and (4) development and evaluation of nursing care plans. Students first work in main groups, then form expert groups according to assigned subtopics, and finally return to their main groups to teach their peers and complete group discussions.

Outcome assessments are conducted at three time points: baseline (pre-test), 15 days after completion of the intervention (post-test), and one month after the intervention (retention test). The primary outcome is nursing students' perceptions of spirituality and spiritual care. Secondary outcomes include the frequency of spiritual care therapeutics, nursing care plan performance scores, and (in the Jigsaw group) student evaluations of the Jigsaw learning method.

In addition to self-report scales, students' nursing care plans prepared during clinical internships are evaluated using a standardized 100-point scoring system based on the nursing process stages. Care plan evaluation includes assessment components related to spiritual care, identification of relevant nursing diagnoses, formulation of goals and expected outcomes, planning of nursing interventions, documentation, and evaluation of care outcomes.

Data are analyzed using appropriate parametric statistical methods. Baseline comparability of groups is examined using chi-square tests for categorical variables and one-way ANOVA for continuous variables. Changes in outcome measures across time and between groups are assessed using repeated measures ANOVA and one-way ANOVA, and post hoc comparisons are performed using the LSD test. Statistical significance is set at p < 0.05.

nclusion Criteria:

Fourth-year undergraduate nursing students enrolled at the Faculty of Health Sciences of Recep Tayyip Erdogan University (Türkiye).

Actively participating in clinical internship placements during the study period.

Willing to participate and providing written informed consent.

Not having received formal education or training specifically focused on spirituality or spiritual care during undergraduate nursing education.

Exclusion Criteria:

Students who did not provide informed consent.

Students who previously received formal education/training on spiritual care.

Students who were not active nursing students during the data collection period.

Students with incomplete post-test or retention-test data.

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Individual participant data will not be shared to protect participant confidentiality and in accordance with ethical approval and informed consent restrictions.