Sustainable healthcare education using cooperative simulation in developing nursing students' knowledge, attitude and skills: A randomized controlled study

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dc.authoridILASLAN, Nagihan/0000-0001-7895-040X
dc.authoridSAHIN ORAK, Nuray/0000-0002-9356-2971
dc.contributor.authorIlaslana, Nagihan
dc.contributor.authorOrak, Nuray Sahin
dc.date.accessioned2025-10-11T20:48:28Z
dc.date.available2025-10-11T20:48:28Z
dc.date.issued2025
dc.departmentDüzce Üniversitesien_US
dc.description.abstractBackground: The effectiveness of sustainable healthcare education in improving nursing students' knowledge and attitudes has been demonstrated through short-term studies with pre-post test design. However, there is a need to study long-term retention of students' knowledge and attitudes, also their skills in achieving sustainable healthcare from the use to disposal of healthcare resources by providing a hands-on learning experience via simulation. Aim: This study investigated the effects of sustainable healthcare education using cooperative simulation on nursing baccalaureate students' sustainable nursing knowledge, attitude and skills by comparing the self-directed learning. Design: This randomized controlled experimental study with pre-post-follow up design was registered under ClinicalTrials.gov with number NCT05504421. Settings: The study was conducted at a nursing faculty in a state university. Participants: The study sample comprised 70 third grade nursing students. Methods: Following narrative-based lectures explaining sustainability in nursing, students were randomly assigned to two study groups; an intervention group using cooperative learning-based NurSusToolkit Project cases and the control group using self-directed learning throughout 4 consecutive weeks. Both groups then performed a high-fidelity simulation practice focusing on sustainable healthcare. Data were collected using the Sustainability Attitudes in Nursing Survey, Sustainable Healthcare Knowledge Form, Skill Checklist and Debriefing Form. Quantitative data were analyzed using t-tests, Friedman test, Fisher's Exact test, intraclass correlation coefficients and Cohen Kappa calculations in IBM SPSS Statistics version 23 software. Qualitative data were analyzed via an inductive approach. Ethical approval and official permission were obtained. The students completed informed consent forms. Results: In the post-test, no significant differences were determined between the groups in terms of sustainable nursing knowledge (U = 557.5, p = 0.503), motivation (U = 514.5, p = 0.237) and attitudes (U = 610, p = 0.976). In the follow-up test, the sustainable nursing knowledge (U = 221.500), motivation (U = 282.500) and attitudes (U = 191) were significantly higher in the intervention group (p < 0.001). In the simulation practice, the intervention group had higher rates of correct separation of nursing care-related waste (intervention group = 77.77 % for both observers, the control group was 0 % and 11.11 % for observer 1 and 2, respectively, Cohen Kappa = 0.898, p < 0.001). In the debriefing, the intervention group requested more simulation practices (33.33 %) to acquire sustainable nursing skills, while the control group did not. Conclusions: Sustainable healthcare education using cooperative simulation that has long-term effects can enable future nurses to lead the shift towards climate-smart and sustainable nursing care.en_US
dc.identifier.doi10.1016/j.nedt.2025.106706
dc.identifier.issn0260-6917
dc.identifier.issn1532-2793
dc.identifier.pmid40139038en_US
dc.identifier.scopus2-s2.0-105000628169en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1016/j.nedt.2025.106706
dc.identifier.urihttps://hdl.handle.net/20.500.12684/21942
dc.identifier.volume151en_US
dc.identifier.wosWOS:001457796300001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherChurchill Livingstoneen_US
dc.relation.ispartofNurse Education Todayen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.snmzKA_WOS_20250911
dc.subjectClimate changeen_US
dc.subjectCooperative learningen_US
dc.subjectSustainabilityen_US
dc.subjectNursing educationen_US
dc.subjectHigh-fidelity simulationen_US
dc.subjectNursing studentsen_US
dc.titleSustainable healthcare education using cooperative simulation in developing nursing students' knowledge, attitude and skills: A randomized controlled studyen_US
dc.typeArticleen_US

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