The Effect of Creative Drama Education on Nursing Students' Reflective Thinking and Clinical Decision-Making: A Mixed-Methods Study

This randomized controlled mixed-methods study evaluated the effect of creative drama education on nursing students' reflective thinking and clinical decision-making skills. Participants were randomly assigned to either an experimental group receiving creative drama education (n = 40) or a control group participating in case-based discussion sessions (n = 37). Quantitative data were collected before and after the intervention using validated measurement instruments. Following completion of the intervention, qualitative interviews were conducted with participants from the experimental group to explore their learning experiences and provide a deeper explanation of the quantitative findings.

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Key information

Conditions

NURSİNG EDUCATİON Clinical Decision-Making in Nursing Creative Drama Nursing Students Reflective Thinking

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Agri Ibrahim Cecen University

Ağrı, Merkez, 04100, Turkey (Türkiye)

About this study

Reflective thinking and clinical decision-making are essential competencies for nursing students to deliver safe, evidence-based, and patient-centered care. Active learning approaches are increasingly recommended to improve these competencies during undergraduate nursing education. Creative drama is an experiential teaching method that promotes active participation, critical reflection, communication, empathy, collaboration, and problem-solving through role-playing, improvisation, and group interaction.

This randomized controlled mixed-methods study investigated whether creative drama education improves nursing students' reflective thinking and clinical decision-making compared with conventional case-based discussion. Undergraduate nursing students were randomly allocated to either an experimental group receiving structured creative drama education (n = 40) or a control group receiving case-based discussion sessions (n = 37). Reflective thinking and clinical decision-making were measured before and after the intervention. Subsequently, qualitative interviews were conducted with students in the experimental group to explore their experiences and explain the quantitative findings.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Undergraduate fourth-year nursing students enrolled in the nursing program.
Aged 18 years or older.
Able to communicate in Turkish.
Available to attend all scheduled educational sessions.

Exclusion criteria

Previous participation in formal creative drama training related to nursing education.
Failure to attend one or more educational sessions.
Withdrawal from the study at any stage.
Incomplete completion of the study questionnaires (pre-test or post-test).

Treatment and study plan

Creative Drama-Based Trainning

Behavioral

Participants in the experimental group received a structured creative drama education program designed to enhance reflective thinking and clinical decision-making skills. The intervention consisted of interactive sessions incorporating warm-up activities, improvisation, role-playing, group enactment of realistic nursing scenarios, reflection, and group discussion. Students actively explored clinical situations by assuming different roles, analyzing patient care problems, and reflecting on their experiences throughout the drama process. The educational content was standardized and delivered by the same instructor using a predefined creative drama program.

Case-Based Discussion

Behavioral

Participants in the control group received conventional case-based discussion sessions covering the same learning objectives as the experimental group. The sessions included instructor-guided analysis of written clinical cases, question-and-answer activities, and group discussions without the use of creative drama techniques or experiential role-play.

Primary outcomes

Reflective Thinking

Time frame: Baseline and immediately after the intervention.

Change in reflective thinking scores measured from baseline to immediately after completion of the educational intervention using a validated reflective thinking scale.
Clinical Decision-Making

Time frame: Baseline and immediately after the intervention.

Change in clinical decision-making scores measured from baseline to immediately after completion of the educational intervention using a validated clinical decision-making scale.

Sponsors and collaborators

Lead sponsor

Agri Ibrahim Cecen University

Other

Registry information

Important dates

Study start: 2025
Primary completion: 2025
Study completion: 2025
First posted: Aug 6, 2026
Registry last updated: Aug 6, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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Completed