The Effect of Case-Based Learning on Self-directed Learning Among Undergraduate Nursing Students: A Quasi-Experimental Study

Abstract

Background: Nursing education requires the development of self-directed learning (SDL) to prepare students for clinical practice. Case-based learning (CBL) is an active pedagogical approach that may enhance SDL; however, evidence among undergraduate nursing students remains limited. Objectives: This study aimed to evaluate the effectiveness of CBL in promoting self-directed learning among undergraduate nursing students. Methods: A quasi-experimental two-group pretest/posttest design was used. A census sampling method was used to recruit all eligible students. Eighty-five undergraduate nursing students at Abadan University of Medical Sciences, Iran, who were enrolled in Adult-Elderly Nursing internships during 2024 - 2025, were randomly assigned to the experimental group (n = 42) or control group (n = 43) using simple randomization with a computer-generated random number sequence generated by a blinded independent researcher. The experimental group received CBL during theoretical sessions, whereas the control group received traditional lectures. The intervention comprised 10 sessions, each including 2 hours of CBL-based theoretical instruction. Self-directed learning was assessed using the Self-Directed Learning Readiness Scale (SDLRS). Data were analyzed using descriptive statistics, paired and independent t-tests, analysis of covariance (ANCOVA), and correlation analyses in SPSS version 28.0. Results: A total of 85 undergraduate nursing students were analyzed (intervention: n = 42; control: n = 43). Postintervention SDL scores were significantly higher in the experimental group (M = 153.30, SD = 18.75) than in the control group (M = 141.95, SD = 18.51; t(83) = 2.78, P = 0.007, d = 0.61). Within-group analyses indicated a large improvement in the experimental group (M change = 14.60, SD = 7.44; d = 1.96, P < 0.001), whereas the control group showed negligible change (M change = 0.10, SD = 1.52; d = 0.07, P = 0.678). An analysis of covariance confirmed a large group effect (ηp2 = 0.61, P < 0.001). Baseline interest in nursing was positively correlated with SDL change (r = 0.42, P < 0.001). Conclusions: Case-based learning significantly improved SDL among undergraduate nursing students and promoted autonomy and lifelong learning. Integrating CBL into the curriculum may enhance clinical preparedness; however, further research is needed to evaluate long-term effects and broader generalizability.