Detailed Description

This randomized controlled trial aims to compare the effectiveness of three educational approaches in improving nursing students' knowledge, clinical skill performance, and self-efficacy regarding sterile urine specimen collection from an indwelling urinary catheter. The study will be conducted during the Spring semester of the 2025-2026 academic year in the Nursing Skills Laboratory at Maltepe University.

The study population will consist of first-year nursing students enrolled in the Fundamentals of Nursing course. Students aged 18 years or older who voluntarily agree to participate will be eligible. Students who have previously received training or have experience in collecting sterile urine specimens from an indwelling urinary catheter will be excluded from the study.

Phase 1: Selection and Training of Peer Educators

Peer educators will be selected from volunteer fourth-year nursing students who have previous mentoring experience with first-year students and a grade point average above 3.0. Before the intervention, peer educators will receive standardized training from the principal investigator using Peyton's Four-Step Teaching Approach. The training will focus on sterile urine specimen collection from an indwelling urinary catheter and will be based on a validated procedural checklist with excellent reliability. During the training, peer educators will complete all four stages of Peyton's model, including demonstration, deconstruction, comprehension, and performance with structured feedback to ensure standardized instruction throughout the study.

Phase 2: Theoretical Education, Baseline Assessment, and Randomization

All eligible first-year nursing students will receive a four-hour theoretical lecture delivered by the course instructor before practical training. The theoretical content will include urinary system anatomy and physiology, urinary elimination and assessment, urinary catheterization, sterile urine specimen collection from an indwelling urinary catheter, and prevention of catheter-associated urinary tract infections.

Following the theoretical session, participants will complete baseline assessments consisting of a Demographic Information Form, a Knowledge Test, and the Student Self-Efficacy Scale.

Participants will then be randomly assigned in a 1:1:1 ratio to one of three study groups:

Peyton Four-Step Teaching delivered by the course instructor. Peyton Four-Step Teaching delivered by trained peer educators. Traditional demonstration-based instruction delivered by the course instructor (control group).

Randomization will be performed by an independent researcher who is not involved in participant recruitment, intervention delivery, or outcome assessment. A computer-generated block randomization sequence (block size = 6) created using Randomizer.org will be used to ensure balanced allocation among groups. Allocation concealment will be maintained using sequentially numbered, opaque, sealed envelopes. The researcher responsible for outcome assessment will remain blinded to group allocation throughout the study.

Phase 3: Practical Skills Training

Following randomization, students will receive practical training according to their assigned group. The two intervention groups will be taught using Peyton's Four-Step Teaching Approach by either the course instructor or trained peer educators. This approach consists of demonstration, deconstruction with step-by-step explanation, comprehension through learner-guided instruction, and independent performance with structured feedback. The control group will receive conventional demonstration-based instruction in which the instructor demonstrates and explains the procedure before students independently perform the skill.

All practical sessions will be conducted individually in the nursing skills laboratory using simulation manikins. Student performance during training will follow the same validated procedural checklist to ensure standardization across groups.

Phase 4: Post-Intervention Assessment

After completing the practical training, participants will complete the Knowledge Test, Student Self-Efficacy Scale, and a Student Satisfaction Questionnaire developed by the researchers. Clinical skill performance will be evaluated by a blinded assessor using the validated procedural checklist employed throughout the intervention. Statistical analyses will be performed by an independent researcher who is not involved in the intervention or assessment process.

This study is designed to determine whether Peyton's Four-Step Teaching Approach, delivered either by faculty members or trained peer educators, provides superior educational outcomes compared with conventional demonstration-based instruction. Participation in the study is entirely voluntary. The assessments are conducted solely for research purposes and will not contribute to students' course grades, academic achievement, or formal performance evaluation.