Creative drama and case-based learning for forgiveness education in difficult patient encounters among nursing students: a randomized controlled trial

Abstract Objective This study aimed to evaluate the effects of creative drama-supported and case-based forgiveness training on nursing students’ forgiveness of others and self-forgiveness in the context of difficult patient encounters. Background Difficult patient behaviors may evoke negative emotions such as anger, frustration, and helplessness among nurses and nursing students. Although forgiveness has been suggested as a potential coping resource for managing these emotions, evidence regarding effective approaches for fostering forgiveness in nursing education remains limited. Design A randomized controlled pretest-posttest study. Methods 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 the creative drama group ( n = 40) or the case-based learning group ( n = 40). Data were collected using the Personal Information Form, the Forgiveness of Others Scale, and the Self-Forgiveness Scale. Both groups participated in four educational sessions (200 min in total). Data were analyzed using independent-samples t -test, paired-samples t -test, analysis of covariance (ANCOVA), Mann–Whitney U test, and Wilcoxon signed-rank test, as appropriate. Results Both educational approaches significantly increased students’ forgiveness of others scores ( p < 0.001). However, after controlling for baseline Forgiveness of Others Scale scores using ANCOVA, posttest forgiveness of others scores were significantly higher in the creative drama group than in the case-based learning group (F(1, 77) = 12.899, p = 0.001, partial η 2 = 0.143). The creative drama intervention demonstrated a very large within-group effect (d = 1.42), whereas the case-based learning intervention demonstrated a large effect (d = 1.00). No significant changes were observed in self-forgiveness scores in either group ( p > 0.05). Conclusions The findings suggest that forgiveness skills in the context of difficult patient encounters can be supported through structured educational interventions. Both creative drama and case-based learning increased nursing students’ forgiveness of others. However, creative drama produced a stronger effect, suggesting that experiential learning processes may be particularly effective in fostering forgiveness of others. In contrast, neither educational approach resulted in a significant improvement in self-forgiveness levels. Trial registration ClinicalTrials.gov, Registration No. NCT07670481, registered on 26 June 2026. Retrospectively registered.