Pecha Kucha-Based ERAS Education in Cardiovascular Surgery: Effects on Nursing Students' Knowledge and Attitudes

The global competition and evolving healthcare needs of the 21st century have highlighted the inadequacy of traditional classroom-based learning methods. Due to the limited attention span of Generation Z and their tendency to become easily bored with monotony and repetition, modifications in conventional teaching methods have become necessary. Developing essential skills such as problem-solving, creativity, collaboration, and media literacy in nursing education is crucial to enhance the learning process and improve learning outcomes. These skills help students cope with challenges in both their professional and social lives. To actively engage nursing students in learning and to support critical thinking and life skills, a combination of teaching methods including lectures, presentations, group discussions, problem-based learning, and role-playing should be employed.

Pecha Kucha (PK) is an internationally recognized, innovative, and visually focused presentation technique used in educational settings. Derived from the Japanese term meaning "chit chat," PK is a slide presentation method based on visuals and narration. The technique consists of 20 slides, each shown for 20 seconds, with the total presentation lasting 6 minutes and 40 seconds. PK provides a practical approach for presenting information in a clear, fluent, and natural manner. Its structured and time-limited format allows presenters to convey key information effectively without deviating from the main topic. The essence of PK lies in the harmonious use of powerful visuals with meaningful and selected text. Therefore, effective presentations require high-quality images or graphics that align with the content, message, and target audience. Each slide presents a single concept or idea with a balanced amount of information, enabling the presenter to communicate content quickly and concisely. The short, visually oriented format helps listeners actively and attentively follow the topic. In health education, PK has been reported as an effective tool for supporting student learning outcomes and instructor objectives compared to traditional PowerPoint presentations.

The use of PK in nursing education has been explored in areas such as knee replacement and nursing approaches, pathophysiology education, development of presentation skills, social anxiety and learning attitudes regarding human papillomavirus infection and vaccination, stoma care skills, and teaching vital signs assessment. Studies by Topal et al. and Bakcek et al. with nursing students reported that PK positively affected student satisfaction. However, no study has evaluated the effect of PK on ERAS (Enhanced Recovery After Surgery) education in nursing students.

With advances in surgical procedures and anesthesia techniques, perioperative patient care has shifted toward evidence-based practice. ERAS protocols, also known as Fast Track Surgery (FTS) programs, are evidence-based interventions applied to reduce physiological stress, minimize morbidity, optimize pain management, and accelerate postoperative recovery. ERAS protocols were initially developed in 2001 by a study group in Northern Europe (Scotland, Sweden, Denmark, Norway, Netherlands) to accelerate recovery after elective colorectal surgery. Later, protocols were adapted for gynecologic oncology, urology, other gastrointestinal surgeries (pancreas, stomach, hepatobiliary, bariatric, rectal/pelvic surgery), and orthopedic surgery. The establishment of the ERAS Society in Stockholm in 2012 further increased the importance of these protocols. Although ERAS protocols have become standard practice in many surgical fields, their application in cardiovascular surgery has only started since 2019. ERAS programs require an interdisciplinary approach, with coordination and collaboration among surgeons, nurses, anesthesiologists, physiotherapists, and dietitians. The success of ERAS depends on strict adherence to the protocol, and nurses constitute a critical component of this program. Increasing awareness of ERAS protocols is essential for improving patient outcomes in cardiovascular surgery.

Surgical nursing focuses on restoring and maintaining an individual's health and well-being through the identification of physical, psychological, and social needs before, during, and after surgical interventions, using evidence-based nursing care. Within ERAS protocols, nurses play vital roles throughout the perioperative process from preoperative patient education to post-discharge follow-up. Responsibilities include keeping up with current evidence-based practices, guiding implementation, maintaining workflow continuity, preparing patient education materials, and organizing and supervising care units. Thus, nurses are indispensable in ensuring the effective implementation of ERAS protocols.

Several studies in Turkey have reported low awareness and implementation of ERAS protocols among clinical nurses. Çelebi and İlçe found that 86.8% of nurses had never heard of ERAS, and 79.2% reported no ERAS practices in their clinics. Ongun and Ak reported that 84.25% of nurses lacked knowledge of ERAS, 88.97% indicated that their clinics did not implement ERAS practices, and 99.21% had neither followed relevant publications nor received ERAS training. Güzel and Yava confirmed low knowledge levels but a strong interest in receiving education. Akpolat et al. applied escape-room learning for ERAS education in nursing students, which improved their knowledge. Student-centered approaches, compared to traditional teaching, present intensive information in shorter periods, enhancing interaction and retention. Feedback from the Surgical Nursing course suggests that students' attention span is limited and conventional PowerPoint presentations with dense theoretical content result in lower achievement. Despite the inclusion of ERAS in surgical nursing, students remain unclear about ERAS components and clinical application. Furthermore, despite understanding the importance of evidence-based care, ERAS-related courses are rarely integrated into nursing curricula.

No study has examined the effectiveness of PK-based ERAS education in cardiovascular surgery for second-year nursing students. This study aims to determine the impact of PK-based ERAS education on students' knowledge and attitudes toward evidence-based practice. To our knowledge, this will be the first such study conducted in Turkey. The results are expected to determine nursing students' knowledge levels and attitudes toward ERAS in cardiovascular surgery and may guide integration of PK methods into curricula for critical subjects such as evidence-based practice. Additionally, findings may contribute to achieving sustainable development goals related to quality education and healthy, high-quality life outcomes.

Research Questions:

Does PK-based ERAS education in cardiovascular surgery improve students' theoretical knowledge?

Does PK-based ERAS education improve students' attitudes toward evidence-based nursing?

Objectives:

To assess differences in knowledge of ERAS protocols between students receiving PK-based and traditional PowerPoint-based education.

To assess differences in attitudes toward evidence-based nursing between the two groups.

Study Design:

This randomized controlled trial with pre- and post-test measurements will follow CONSORT guidelines and will be registered in ClinicalTrials.gov prior to commencement.

Study Setting and Duration:

The study will be conducted at Lokman Hekim University Faculty of Health Sciences, Department of Nursing, from April 15, 2026, to June 15, 2026.

Population and Sample:

The population consists of 71 second-year nursing students enrolled in the Surgical Nursing course. Participants will be randomly assigned to the intervention group (PK-based education) or control group (PowerPoint-based education) using block randomization based on pre-test ERAS knowledge scores (≤60 / >60) and gender. Randomization will be performed using https://www.randomizer.org/

Data Collection Instruments:

Student Demographic Form: Age, gender, prior ERAS knowledge, satisfaction with ERAS education.

ERAS Knowledge Test: Pre- and post-test including 36 true/false items and 10 open-ended questions. Total score 0-100.

Evidence-Based Nursing Attitude Scale (EBNAS): 15-item Likert scale measuring beliefs, intention, and feelings toward evidence-based practice. Cronbach α = 0.90.

Data will be collected face-to-face. Written informed consent will be obtained. Pre-tests will be conducted one week prior to the topic session. Intervention group will receive PK-based education, and control group PowerPoint-based education. Post-tests will be conducted immediately after training and repeated one month later to assess retention. After midterm exams, the control group will also receive PK-based education to ensure equal learning opportunities.

Data Analysis:

Analyses will be conducted by an independent statistician using IBM SPSS 26. Descriptive statistics, normality tests (Kolmogorov-Smirnov and Shapiro-Wilk), independent sample t-tests or Mann-Whitney U tests, paired sample t-tests or Wilcoxon signed-rank tests, and chi-square tests will be used. Significance set at p < 0.05.