Perceptions and Barriers to Innovative Teaching-Learning Approaches among Diploma Nursing Students in Sri Lanka : A Cross-Sectional Study

Introduction: Innovative teaching learning approaches such as simulation, problem-based learning, and technology-supported learning are increasingly used to strengthen critical thinking, clinical competence, and student engagement. However, their use in diploma nursing education in low- and middle-income settings, including Sri Lanka, remains limited, and there is relatively little evidence about how students view these approaches and the barriers they experience. Aim: This study aimed to assess third-year diploma nursing students’ exposure to, preferences for, and perceptions of innovative teaching-learning approaches and to identify the main barriers that limit their use. Methods: A descriptive cross-sectional study was carried out among 423 third-year nursing students from eight Nurses’ Training Schools under the Ministry of Health, Sri Lanka. The schools were selected using multi-stage cluster sampling, followed by systematic random sampling of individual students. Data were collected with a pre-validated, self-administered structured questionnaire (Cronbach’s alpha >0.9). The questionnaire covered exposure, preferences, perceived strengths and weaknesses, and barriers related to innovative approaches. All selected students responded (100% response rate). Descriptive statistics were used to summarize the findings, while independent-samples t-tests and one-way ANOVA were used to examine associations with demographic factors. Results: Problem-based learning and case-based learning were the innovative approaches most often reported as being used frequently by teachers (47.5% each). In contrast, technology-supported approaches such as virtual/augmented reality, flipped classrooms, and blended learning were used rarely or not at all by many students (55-64%). Students nevertheless showed strong preferences for innovative approaches, especially interprofessional education (98.1%) and case-based learning (97.6%), and most recognized their contribution to engagement, critical thinking, and collaboration. When the overall perception score was considered, however, only 0.5% of students fell into the high-perception category, compared with 57.9% with moderate perception and 41.6% with low perception. The main barriers included lack of time (up to 63.8% for problem-based learning), cost and limited access to technology (26-40%), limited clinical-staff support for simulation (18.9%), and concerns that AI-supported learning could reduce critical thinking (35-47%). Conclusion: Diploma nursing students generally viewed innovative teaching–learning approaches positively and recognized their educational value. However, limited exposure and structural, technological, and resource-related barriers appear to restrict their wider use. Greater attention to infrastructure, faculty development, and curriculum integration is needed to turn students’ positive attitudes into regular educational practice and better prepare them for contemporary nursing care.