Educational ProblemsNCT07441577
The Effect of the Fishbowl Method on Nursing Students
A study testing Fishbowl Teaching Method in people with Educational Problems, run by Zeynep Yılmaz at 1 site in Turkey (Türkiye).
Trial summary
Background: Breathing and coughing exercises are fundamental components of nursing care in the management of chronic respiratory diseases, and the way students learn these skills is closely related to their clinical skill development. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Educational Problems
- What is being tested?
- Fishbowl Teaching Method
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 63 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 28 Apr 2025to 29 Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Fundamentals of Nursing course
- Voluntarily agreed
Who cannot join
- Previous clinical training on breathing and coughing exercises
- Withdrawal from the study at any stage
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Observe, Discuss, and Learn: The Effect of the Fishbowl Method on Nursing Students' Knowledge, Self-efficacy, and Motivation in Breathing and Coughing Exercise Education
Background:
Breathing and coughing exercises are fundamental components of nursing care in the management of chronic respiratory diseases, and the way students learn these skills is closely related to their clinical skill development. Active learning approaches that combine observation and participation may support skill acquisition more effectively than passive instruction. The Fishbowl teaching method is an interactive approach that allows students to learn through structured observation, discussion, and practice. However, its use in teaching breathing and coughing exercises in nursing education has not yet been examined. This study aims to evaluate the effect of the Fishbowl teaching method on nursing students' learning experience in the instruction of breathing and coughing exercises.
Read more
Methods:
This study is designed as a randomized controlled pretest-posttest experimental study. A total of 63 first-year nursing students will be randomly assigned to either an intervention group or a control group. The intervention group will receive instruction using the Fishbowl teaching method, while the control group will be taught using traditional demonstration-based instruction. Data will be collected using the Knowledge Test, Academic Self-Efficacy Scale, and Instructional Materials Motivation Scale at pretest and posttest time points.
Read the detailed description
Nursing education plays a fundamental role in preparing students to transform theoretical knowledge into safe and effective clinical practice. In addition to increasing knowledge levels, it aims to develop higher-order competencies such as critical thinking, clinical decision-making, and problem-solving. However, traditional information-centered teaching approaches may be insufficient for fostering these competencies. Contemporary educational perspectives emphasize active learning processes involving observation, practice, reflection, and feedback, leading nursing education toward learner-centered and interactive methods that support deeper learning and clinical readiness.
Chronic respiratory diseases remain a major public health concern due to high morbidity and mortality. Nursing care is central to their management, particularly through monitoring respiratory status, symptom control, and patient education. Among non-pharmacological interventions, breathing and coughing exercises are essential for airway clearance, ventilation improvement, treatment adherence, and prevention of complications. Therefore, nurses must be competent not only in performing these exercises but also in teaching them effectively to patients.
Because correct performance directly affects clinical outcomes, these exercises require structured teaching and feedback. Conventional lecture-based instruction often leads to passive participation, whereas interactive strategies enhance engagement and knowledge transfer. One such approach is the Fishbowl method, an interactive small-group strategy in which students alternate between performer and observer roles, followed by feedback and reflection. This structure promotes active participation and clinical reasoning.
Beyond cognitive and psychomotor skills, affective outcomes are also important. Academic self-efficacy-the belief in one's ability to successfully perform a task-strongly influences motivation and performance. Learning environments that include peer observation and active participation may strengthen self-efficacy perceptions. Although the Fishbowl method has been studied for various learning outcomes, its effectiveness in teaching breathing and coughing exercises has not been directly examined. Investigating its impact on nursing students' knowledge, self-efficacy, and motivation therefore represents a relevant area of inquiry.
- Conditions
- Educational Problems
- Being tested
- Fishbowl Teaching Method
- Keywords
- Breathing exercises, Cough exercises, Nursing education, Nursing students, Fishbowl method, Self efficacy, Motivation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Fishbowl Teaching MethodOther
Students in the intervention group (n = 33) were divided into subgroups of 5-6 students to facilitate effective implementation of the Fishbowl method. Six separate sessions were conducted using the same scenario ensuring content standardization. Before the sessions, students received a briefing from the faculty member responsible for the Fundamentals of Nursing laboratory course. The scenario was distributed in print, roles (student nurse, patient, observer) were explained, and students were given 10-15 minutes to review the case and voluntarily select roles; the researcher acted only as a facilitator. During the session, inner-circle students performed the application while outer-circle students evaluated performance using the Fishbowl Observation Form. After each session, structured feedback was provided by the observers and faculty member, and strengths and areas for improvement were discussed. Each session lasted approximately 25-30 minutes.
| Study group | Role | What they receive |
|---|---|---|
| Fishbowl Group | Experimental | The intervention group received instruction using the Fishbowl method. Receives: Other: Fishbowl Teaching Method |
| Control group | No intervention | In the control group, the implementation was conducted using the traditional laboratory demonstration method. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Knowledge Test
The Knowledge Test was developed by the researchers to assess students' knowledge of diaphragmatic breathing and effective coughing exercises. Test items were prepared in line with the literature by three researchers who are experts in the Fundamentals of Nursing discipline. The development of the items was informed by core Fundamentals of Nursing textbooks and up-to-date nursing education literature, resulting in a 15-item multiple-choice test with four response options for each item. The test consisted of two main content domains: diaphragmatic breathing (Items 1-8) and effective coughing exercises (Items 9-15). Each item had a single correct answer. The internal consistency reliability (Cronbach's alpha) of the Knowledge Test was 0.70 for the pretest and 0.78 for the posttest.
Measured: 1 week
The Academic Self-Efficacy Scale (ASES)
The Academic Self-Efficacy Scale (ASES) was originally adapted into Turkish by Yılmaz et al.. The scale is unidimensional and consists of seven items assessing perceived academic self-efficacy. Responses are rated on a four-point Likert scale ranging from 1 ("Does not apply to me at all") to 4 ("Applies to me completely"), with total scores ranging from 7 to 28. Higher scores indicate higher levels of perceived academic self-efficacy. The Cronbach's alpha coefficient of the Turkish version of the scale was reported as 0.79. In the present study, Cronbach's alpha values were 0.85 for the pretest and 0.89 for the posttest.
Measured: 1 week
The Instructional Materials Motivation Survey (IMMS)
The Instructional Materials Motivation Survey (IMMS) was developed by Keller and adapted into Turkish by Dinçer and Doğanay. The IMMS consists of 33 items across four subdimensions: attention, relevance, confidence, and satisfaction. Items are rated on a five-point Likert scale ranging from 1 ("Not true") to 5 ("Very true"), yielding total scores between 33 and 165. Higher scores indicate higher levels of motivation toward instructional materials. The Cronbach's alpha reliability coefficient of the Turkish version of the IMMS was reported as 0.96. In this study, the overall Cronbach's alpha values were 0.98 for the pretest and 0.99 for the posttest.
Measured: 1 week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Mar 2026
- Study start28 Apr 2025
- Primary completion23 May 2025
- Study completion29 Aug 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Educational ProblemsStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 63 participants (actual)
Sponsor and investigators
- Lead sponsor
- Zeynep Yılmaz
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Zeynep Yılmaz, Ataturk University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07441577
- Sponsor's protocol ID
- Melekada
- Status last verified
- Feb 2026
- First submitted
- 23 Feb 2026
- Last updated
- 2 Mar 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Observe, Discuss, and Learn: The Effect of the Fishbowl Method on Nursing Students' Knowledge, Self-efficacy, and Motivation in Breathing and Coughing Exercise Education
- ClinicalTrials.gov ID
- NCT07441577
- Acronym / sponsor ID
- Melekada
- Conditions
- Educational Problems
- Keywords
- Breathing exercises, Cough exercises, Nursing education, Nursing students, Fishbowl method, Self efficacy, Motivation
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 63 participants (actual)
- Lead sponsor
- Zeynep YılmazUniversity, hospital or other
- Study start
- 28 Apr 2025 (actual)
- Primary completion
- 23 May 2025 (actual)
- Study completion
- 29 Aug 2025 (actual)
- First posted
- 2 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Background:
Breathing and coughing exercises are fundamental components of nursing care in the management of chronic respiratory diseases, and the way students learn these skills is closely related to their clinical skill development. Active learning approaches that combine observation and participation may support skill acquisition more effectively than passive instruction. The Fishbowl teaching method is an interactive approach that allows students to learn through structured observation, discussion, and practice. However, its use in teaching breathing and coughing exercises in nursing education has not yet been examined. This study aims to evaluate the effect of the Fishbowl teaching method on nursing students' learning experience in the instruction of breathing and coughing exercises.
Methods:
This study is designed as a randomized controlled pretest-posttest experimental study. A total of 63 first-year nursing students will be randomly assigned to either an intervention group or a control group. The intervention group will receive instruction using the Fishbowl teaching method, while the control group will be taught using traditional demonstration-based instruction. Data will be collected using the Knowledge Test, Academic Self-Efficacy Scale, and Instructional Materials Motivation Scale at pretest and posttest time points.
Detailed description
Nursing education plays a fundamental role in preparing students to transform theoretical knowledge into safe and effective clinical practice. In addition to increasing knowledge levels, it aims to develop higher-order competencies such as critical thinking, clinical decision-making, and problem-solving. However, traditional information-centered teaching approaches may be insufficient for fostering these competencies. Contemporary educational perspectives emphasize active learning processes involving observation, practice, reflection, and feedback, leading nursing education toward learner-centered and interactive methods that support deeper learning and clinical readiness.
Chronic respiratory diseases remain a major public health concern due to high morbidity and mortality. Nursing care is central to their management, particularly through monitoring respiratory status, symptom control, and patient education. Among non-pharmacological interventions, breathing and coughing exercises are essential for airway clearance, ventilation improvement, treatment adherence, and prevention of complications. Therefore, nurses must be competent not only in performing these exercises but also in teaching them effectively to patients.
Because correct performance directly affects clinical outcomes, these exercises require structured teaching and feedback. Conventional lecture-based instruction often leads to passive participation, whereas interactive strategies enhance engagement and knowledge transfer. One such approach is the Fishbowl method, an interactive small-group strategy in which students alternate between performer and observer roles, followed by feedback and reflection. This structure promotes active participation and clinical reasoning.
Beyond cognitive and psychomotor skills, affective outcomes are also important. Academic self-efficacy-the belief in one's ability to successfully perform a task-strongly influences motivation and performance. Learning environments that include peer observation and active participation may strengthen self-efficacy perceptions. Although the Fishbowl method has been studied for various learning outcomes, its effectiveness in teaching breathing and coughing exercises has not been directly examined. Investigating its impact on nursing students' knowledge, self-efficacy, and motivation therefore represents a relevant area of inquiry.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Fishbowl Group | Experimental | Other: Fishbowl Teaching MethodThe intervention group received instruction using the Fishbowl method. |
| Control group | No intervention | –In the control group, the implementation was conducted using the traditional laboratory demonstration method. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Fundamentals of Nursing course
- Voluntarily agreed
Key exclusion criteria (2 listed)
- Previous clinical training on breathing and coughing exercises
- Withdrawal from the study at any stage
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Fishbowl Teaching MethodStudents in the intervention group (n = 33) were divided into subgroups of 5-6 students to facilitate effective implementation of the Fishbowl method. Six separate sessions were conducted using the same scenario ensuring content standardization. Before the sessions, students received a briefing from the faculty member responsible for the Fundamentals of Nursing laboratory course. The scenario was distributed in print, roles (student nurse, patient, observer) were explained, and students were given 10-15 minutes to review the case and voluntarily select roles; the researcher acted only as a facilitator. During the session, inner-circle students performed the application while outer-circle students evaluated performance using the Fishbowl Observation Form. After each session, structured feedback was provided by the observers and faculty member, and strengths and areas for improvement were discussed. Each session lasted approximately 25-30 minutes. | Other | Fishbowl Group |
Primary outcome
Knowledge Test
Time frame: 1 week
The Knowledge Test was developed by the researchers to assess students' knowledge of diaphragmatic breathing and effective coughing exercises. Test items were prepared in line with the literature by three researchers who are experts in the Fundamentals of Nursing discipline. The development of the items was informed by core Fundamentals of Nursing textbooks and up-to-date nursing education literature, resulting in a 15-item multiple-choice test with four response options for each item. The test consisted of two main content domains: diaphragmatic breathing (Items 1-8) and effective coughing exercises (Items 9-15). Each item had a single correct answer. The internal consistency reliability (Cronbach's alpha) of the Knowledge Test was 0.70 for the pretest and 0.78 for the posttest.
The Academic Self-Efficacy Scale (ASES)
Time frame: 1 week
The Academic Self-Efficacy Scale (ASES) was originally adapted into Turkish by Yılmaz et al.. The scale is unidimensional and consists of seven items assessing perceived academic self-efficacy. Responses are rated on a four-point Likert scale ranging from 1 ("Does not apply to me at all") to 4 ("Applies to me completely"), with total scores ranging from 7 to 28. Higher scores indicate higher levels of perceived academic self-efficacy. The Cronbach's alpha coefficient of the Turkish version of the scale was reported as 0.79. In the present study, Cronbach's alpha values were 0.85 for the pretest and 0.89 for the posttest.
The Instructional Materials Motivation Survey (IMMS)
Time frame: 1 week
The Instructional Materials Motivation Survey (IMMS) was developed by Keller and adapted into Turkish by Dinçer and Doğanay. The IMMS consists of 33 items across four subdimensions: attention, relevance, confidence, and satisfaction. Items are rated on a five-point Likert scale ranging from 1 ("Not true") to 5 ("Very true"), yielding total scores between 33 and 165. Higher scores indicate higher levels of motivation toward instructional materials. The Cronbach's alpha reliability coefficient of the Turkish version of the IMMS was reported as 0.96. In this study, the overall Cronbach's alpha values were 0.98 for the pretest and 0.99 for the posttest.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Mar 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Fishbowl Teaching Method in people with Educational Problems, run by Zeynep Yılmaz at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Knowledge Test (time frame: 1 week). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Mar 2026; AzTrials last refreshed its copy on 6 Nov 2026.