CREATIVE DRAMA-BASED FORGIVENESS EDUCATION FOR DIFFICULT PATIENT ENCOUNTERS AMONG NURSING STUDENTS: A RANDOMIZED CONTROLLED TRIAL

Nursing students interact with patients with diverse characteristics during clinical practice. While some patients are cooperative and communicative, others may display aggressive, anxious, demanding, resistant, manipulative, or verbally abusive behaviors. Such difficult patient behaviors may evoke negative emotions in students, including anger, frustration, helplessness, anxiety, and emotional distress. These experiences may also negatively affect students' caregiving relationships, communication processes, and professional development.

Forgiveness is defined as a dynamic process through which individuals transform negative emotions, such as anger, resentment, hostility, and the desire for revenge, into more understanding, accepting, and compassionate responses. In addition to forgiving others, self-forgiveness may help individuals acknowledge their own mistakes and cope more adaptively with feelings of guilt, regret, and self-criticism. Therefore, forgiveness is considered an important personal and professional resource that may support healthcare professionals and students in coping with difficult interpersonal experiences.

However, evidence regarding effective educational approaches for fostering forgiveness in nursing education remains limited. The abstract and multidimensional nature of forgiveness requires students not only to understand the concept theoretically but also to experience it, develop different perspectives, and cultivate empathy. In this context, student-centered and experiential teaching methods, such as creative drama and case-based learning, may represent potentially useful approaches for developing forgiveness skills.

This randomized controlled pretest-posttest study aimed to evaluate the effects of creative drama-based and case-based forgiveness education on nursing students' forgiveness of others and self-forgiveness in the context of difficult patient encounters. The study was conducted with 80 fourth-year nursing students enrolled in the nursing department of a university in Eastern Türkiye. Participants were randomly assigned to either a creative drama group (n=40) or a case-based learning group (n=40).

Both groups participated in four structured educational sessions totaling 200 minutes. The interventions were based on difficult patient scenarios and were organized around the themes of forgiveness of others and self-forgiveness. In the creative drama group, students actively participated in role-playing, enactment, perspective-taking, empathy development, and reflective activities. In the case-based learning group, students analyzed the same scenarios, identified problems, discussed potential causes, and evaluated alternative courses of action. Outcomes were assessed using the Forgiveness of Others Scale and the Self-Forgiveness Scale before and immediately after the intervention.