Problem-Based Learning to Improve Critical Thinking in Obstetric Nursing Students

This study is a cluster randomized controlled trial designed to evaluate the effect of a problem-based learning (PBL) instructional approach on critical thinking, clinical decision-making, and knowledge acquisition and retention among undergraduate obstetric nursing students. The study was conducted in classroom settings at the Faculty of Nursing, Benha University, Benha, Egypt, during the first semester of the 2025-2026 academic year.

Eligible participants were third-level undergraduate nursing students enrolled in the obstetrics nursing course. Academic groups were used as the unit of randomization to minimize contamination between students. From the available academic groups, 12 clusters were randomly selected and allocated in a 1:1 ratio to either the intervention group (PBL) or the control group (traditional lecture-based instruction). All eligible students within the selected clusters were included, resulting in a total sample of 312 students.

At baseline, participants in both groups completed assessments measuring demographic characteristics, knowledge acquisition, critical thinking, and clinical decision-making. Following baseline assessment, control clusters received traditional lecture-based instruction covering normal labor, preeclampsia/eclampsia, and postpartum hemorrhage according to the standard course syllabus. Intervention clusters participated in a structured PBL program addressing the same topics using standardized clinical case scenarios and guided facilitation. The intervention emphasized problem identification, self-directed learning, group discussion, and application of knowledge to clinical decision-making.

Outcome measures were collected immediately after completion of the instructional period and again four weeks later to evaluate knowledge retention and sustained development of critical thinking and clinical decision-making skills. Validated instruments were used to assess critical thinking and clinical decision-making, while a researcher-developed, case-based multiple-choice questionnaire was used to assess knowledge acquisition and retention. Ethical approval was obtained from the Scientific Research Ethics Committee of the Faculty of Nursing, Helwan University prior to study initiation. Participation was voluntary, and informed consent was obtained from all participants.

Inclusion criteria

• Undergraduate nursing students enrolled in the third academic level of the Obstetrics and Gynecology Nursing course at the Faculty of Nursing, Benha University.
• Aged 18 to 21 years at the time of enrollment.
• Regular attendance in the course during the study period.
• Willingness to participate and provide written informed consent.
• No prior formal exposure to structured problem-based learning (PBL).
• Completion of baseline assessment prior to participation.