An interventional study of Peyton Four-Step Teaching Model and Traditional Demonstration-Based Teaching in Nursing Education and Clinical Skills Training, sponsored by Maltepe University. Not yet recruiting at 1 site in Turkey (Türkiye). Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-08-07.
Sponsored by Maltepe University · Not applicable, Interventional, and Other
Detailed Description
This randomized controlled trial aims to compare the effectiveness of three educational approaches in improving nursing students' knowledge, clinical skill performance, and self-efficacy regarding sterile urine specimen collection from an indwelling urinary catheter. The study will be conducted during the Spring semester of the 2025-2026 academic year in the Nursing Skills Laboratory at Maltepe University.
The study population will consist of first-year nursing students enrolled in the Fundamentals of Nursing course. Students aged 18 years or older who voluntarily agree to participate will be eligible. Students who have previously received training or have experience in collecting sterile urine specimens from an indwelling urinary catheter will be excluded from the study.
Phase 1: Selection and Training of Peer Educators
Peer educators will be selected from volunteer fourth-year nursing students who have previous mentoring experience with first-year students and a grade point average above 3.0. Before the intervention, peer educators will receive standardized training from the principal investigator using Peyton's Four-Step Teaching Approach. The training will focus on sterile urine specimen collection from an indwelling urinary catheter and will be based on a validated procedural checklist with excellent reliability. During the training, peer educators will complete all four stages of Peyton's model, including demonstration, deconstruction, comprehension, and performance with structured feedback to ensure standardized instruction throughout the study.
Phase 2: Theoretical Education, Baseline Assessment, and Randomization
All eligible first-year nursing students will receive a four-hour theoretical lecture delivered by the course instructor before practical training. The theoretical content will include urinary system anatomy and physiology, urinary elimination and assessment, urinary catheterization, sterile urine specimen collection from an indwelling urinary catheter, and prevention of catheter-associated urinary tract infections.
Following the theoretical session, participants will complete baseline assessments consisting of a Demographic Information Form, a Knowledge Test, and the Student Self-Efficacy Scale.
Participants will then be randomly assigned in a 1:1:1 ratio to one of three study groups:
Peyton Four-Step Teaching delivered by the course instructor. Peyton Four-Step Teaching delivered by trained peer educators. Traditional demonstration-based instruction delivered by the course instructor (control group).
Randomization will be performed by an independent researcher who is not involved in participant recruitment, intervention delivery, or outcome assessment. A computer-generated block randomization sequence (block size = 6) created using Randomizer.org will be used to ensure balanced allocation among groups. Allocation concealment will be maintained using sequentially numbered, opaque, sealed envelopes. The researcher responsible for outcome assessment will remain blinded to group allocation throughout the study.
Phase 3: Practical Skills Training
Following randomization, students will receive practical training according to their assigned group. The two intervention groups will be taught using Peyton's Four-Step Teaching Approach by either the course instructor or trained peer educators. This approach consists of demonstration, deconstruction with step-by-step explanation, comprehension through learner-guided instruction, and independent performance with structured feedback. The control group will receive conventional demonstration-based instruction in which the instructor demonstrates and explains the procedure before students independently perform the skill.
All practical sessions will be conducted individually in the nursing skills laboratory using simulation manikins. Student performance during training will follow the same validated procedural checklist to ensure standardization across groups.
Phase 4: Post-Intervention Assessment
After completing the practical training, participants will complete the Knowledge Test, Student Self-Efficacy Scale, and a Student Satisfaction Questionnaire developed by the researchers. Clinical skill performance will be evaluated by a blinded assessor using the validated procedural checklist employed throughout the intervention. Statistical analyses will be performed by an independent researcher who is not involved in the intervention or assessment process.
This study is designed to determine whether Peyton's Four-Step Teaching Approach, delivered either by faculty members or trained peer educators, provides superior educational outcomes compared with conventional demonstration-based instruction. Participation in the study is entirely voluntary. The assessments are conducted solely for research purposes and will not contribute to students' course grades, academic achievement, or formal performance evaluation.
Maltepe University is the lead sponsor of 67 studies on the registry; 7 are open to participants now.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants assigned to this arm will receive practical training in sterile urine specimen collection from an indwelling urinary catheter using the Peyton Four-Step Teaching Model delivered by the course instructor. The intervention consists of demonstration, deconstruction, comprehension, and independent performance with structured feedback. Training will be conducted individually in the nursing skills laboratory using simulation manikins and a standardized procedural checklist.
Behavioral: Peyton Four-Step Teaching Model
Participants assigned to this arm will receive practical training in sterile urine specimen collection from an indwelling urinary catheter using the Peyton Four-Step Teaching Model delivered by trained peer educators. Peer educators will be fourth-year nursing students who have successfully completed the relevant course and received standardized training from the course instructor before the intervention. The training will follow the four sequential steps of the Peyton model: demonstration, deconstruction, comprehension, and independent performance with structured feedback. All training sessions will be conducted individually in the nursing skills laboratory using simulation manikins and a standardized procedural checklist.
Behavioral: Peyton Four-Step Teaching Model
Participants assigned to this arm will receive practical training in sterile urine specimen collection from an indwelling urinary catheter using the traditional demonstration-based teaching method delivered by the course instructor. The instructor will explain and demonstrate the procedure according to the standardized skills checklist, after which participants will practice the procedure individually under supervision and receive feedback. All training sessions will be conducted in the nursing skills laboratory using simulation manikins and the same standardized procedural checklist used in the intervention groups to ensure consistency in educational content and outcome assessment.
Behavioral: Traditional Demonstration-Based Teaching
Participants will receive practical training in sterile urine specimen collection from an indwelling urinary catheter using the Peyton Four-Step Teaching Model. The intervention consists of four sequential steps: demonstration, deconstruction, comprehension, and independent performance with structured feedback. Depending on study group allocation, the training will be delivered either by the course instructor or by trained peer educators. All training sessions will be conducted individually in the nursing skills laboratory using simulation manikins and a standardized procedural checklist to ensure consistency of the educational content and skill assessment
Participants will receive practical training in sterile urine specimen collection from an indwelling urinary catheter using the traditional demonstration-based teaching method. The course instructor will explain and demonstrate the procedure according to the standardized procedural checklist. Following the demonstration, participants will practice the procedure individually under supervision and receive structured feedback. All training sessions will be conducted in the nursing skills laboratory using simulation manikins and the same standardized procedural checklist used in the intervention groups.
Skill performance in sterile urine specimen collection from an indwelling urinary catheter
Skill performance will be evaluated using the Urine Specimen Collection from an Indwelling Urinary Catheter Skills Checklist. Higher scores indicate better procedural skill performance.
Time frame: Immediately after completion of the training intervention
Knowledge level regarding sterile urine specimen collection from an indwelling urinary catheter
Knowledge level will be assessed using a researcher-developed knowledge test. Higher scores indicate greater knowledge regarding sterile urine specimen collection from an indwelling urinary catheter.
Time frame: Before the intervention and immediately after completion of the training intervention
Self-efficacy
Self-efficacy will be assessed using the Student Self-Efficacy Scale. Higher scores indicate greater self-efficacy in performing sterile urine specimen collection from an indwelling urinary catheter.
Time frame: Before the intervention and immediately after completion of the training intervention
Student satisfaction with the educational intervention
Student satisfaction with the educational intervention will be assessed using a researcher-developed satisfaction questionnaire. Higher scores indicate greater satisfaction with the educational method received.
Time frame: Immediately after completion of the training intervention
Plan to share: No — Individual participant data (IPD) collected during this study will not be shared because the study involves educational data collected from undergraduate students, and no data-sharing plan has been established.
No publications or documents are linked to this record.
Start is estimated for Sep 2026; primary completion for Dec 2026, 3 months later.
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Maltepe University