Observe, Discuss, and Learn: The Effect of the Fishbowl Method on Nursing Students' Knowledge, Self-efficacy, and Motivation in Breathing and Coughing Exercise Education

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.