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Journals / Sağlık Akademisi Kastamonu / 2026 / Cilt: 11 Sayı: 2

The Effect of Mandala Coloring on Perceived Stress, Critical Thinking Disposition, and Problem-Solving Skills in Simulation-Based Eclampsia Training: A Randomized Controlled Trial

Simülasyon Temelli Eklampsi Eğitiminde Mandala Boyamanın Algılanan Stres, Eleştirel Düşünme Eğilimi ve Problem Çözme Becerileri Üzerine Etkisi: Randomize Kontrollü Bir Çalışma

Melek Hava Köprülü(KASTAMONU ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, EBELİK BÖLÜMÜ)0000-0001-8282-9565
Ayşenur Durmuş(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0003-0361-8036
Şahika Şimşek Çetinkaya(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0002-4518-5286
Canan Kaş(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0003-1637-0690
Nihal Aydın(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0002-6205-4966
Demet Güney(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0002-4290-9189
Sıla Gül(KASTAMONU UNIVERSITY, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF MIDWIFERY, DEPARTMENT OF MIDWIFERY)0000-0002-5375-4864
Pages
91–104
Publication Date
2026-08-31
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

It may be used as a supportive approach in simulation-based education

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: Mandala coloring is used to support emotional relaxation and mindfulness; however, its effects during high-stress clinical simulation training remain unclear.
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Key Findings & Data:Methods: A randomized controlled trial was conducted with 72 midwifery students, randomly assigned to an intervention group (mandala coloring + simulation, n = 36) or a control group (simulation only, n = 36).
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Conclusion & Impact:It may be used as a supportive approach in simulation-based education
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Sanat terapisi · mandala sanatı · problem çözme

Abstract

Objective: Mandala coloring is used to support emotional relaxation and mindfulness; however, its effects during high-stress clinical simulation training remain unclear. This study aimed to examine its impact on perceived stress, critical thinking disposition, and problem-solving skills among midwifery students. Methods: A randomized controlled trial was conducted with 72 midwifery students, randomly assigned to an intervention group (mandala coloring + simulation, n = 36) or a control group (simulation only, n = 36). Data were collected using the Perceived Stress Scale (PSS), Problem-Solving Inventory (PSI), and UF/EMI Critical Thinking Disposition Instrument before and after the intervention. Results: The intervention group showed a significant decrease in perceived stress and improvement in problem-solving skills (p 0.05). No significant differences were found in the control group. Between-group comparisons revealed significant differences in favor of the intervention group for perceived stress and problem-solving skills (p<0.05), but not for critical thinking disposition. Conclusion: Mandala coloring improved perceived stress and problem-solving skills but did not affect critical thinking disposition. It may be used as a supportive approach in simulation-based education

Özet

Amaç: Mandala boyama, duygusal rahatlama ve bilinçli farkındalığı desteklemek amacıyla kullanılan bir yöntemdir; ancak yüksek stres içeren klinik simülasyon eğitimlerindeki etkileri henüz yeterince açıklığa kavuşturulamamıştır. Bu çalışma, mandala boyamanın ebelik öğrencilerinin algılanan stres, eleştirel düşünme eğilimi ve problem çözme becerileri üzerindeki etkisini incelemek amacıyla gerçekleştirilmiştir. Yöntem: Randomize kontrollü olarak yürütülen bu çalışmaya 72 ebelik öğrencisi dahil edilmiş ve katılımcılar müdahale grubu (mandala boyama + simülasyon, n=36) ve kontrol grubu (yalnızca simülasyon, n=36) olmak üzere rastgele atanmıştır. Veriler, müdahale öncesi ve sonrasında Algılanan Stres Ölçeği (ASÖ), Problem Çözme Envanteri (PÇE) ve UF/EMI Eleştirel Düşünme Eğilimi Ölçeği kullanılarak toplanmıştır. Bulgular: Müdahale grubunda algılanan stres düzeyinde anlamlı azalma ve problem çözme becerilerinde anlamlı iyileşme saptanmıştır (p 0.05). Kontrol grubunda ise ölçek puanlarında anlamlı bir değişim gözlenmemiştir. Gruplar arası karşılaştırmalarda, algılanan stres ve problem çözme becerileri açısından müdahale grubu lehine anlamlı fark bulunurken (p<0.05), eleştirel düşünme eğilimi açısından anlamlı fark saptanmamıştır. Sonuç: Mandala boyamanın algılanan stres düzeyini azaltmada ve problem çözme becerilerini geliştirmede etkili olduğu, ancak eleştirel düşünme eğilimi üzerinde anlamlı bir etkisinin bulunmadığı belirlenmiştir. Mandala boyamanın, simülasyon temelli eğitimlerde destekleyici bir yaklaşım olarak kullanılabileceği düşünülmektedir.

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Cite This Article

Köprülü, M. H., Durmuş, A., Çetinkaya, Ş. Ş., Kaş, C., Aydın, N., Güney, D., Gül, S. (2026). The Effect of Mandala Coloring on Perceived Stress, Critical Thinking Disposition, and Problem-Solving Skills in Simulation-Based Eclampsia Training: A Randomized Controlled Trial. Sağlık Akademisi Kastamonu, Cilt: 11 Sayı: 2, 91–104. https://doi.org/10.25279/sak.1954467

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References (40)

  1. Aini, A. H., Ikhsani, I. T., Cahyani, N. D., Anggraini, S., Mubarak, S., Muffidah, A., Kurniati, D., Zariyatan, I. N. N. L., & Adelia, C. (2024). The effect of mandala coloring on reducing anxiety in students of the Faculty of Psychology UIN Raden Fatah Palembang. Indonesian Journal of Multidisciplinary Science., 3(2), 141-150.
  2. Apriyana, R., Widianti, E., & Muliani, R. (2020). The influence of mandala pattern coloring therapy toward academic stress level on first grade students at nursing undergraduate study program. NurseLine Journal, 5(1), 186-194.
  3. Arıbaş, A. N., & Oğuzhan, Y. S. (2024). Eleştirel Düşünmenin Problem Çözme ve Algılanan Stres Düzeyine Etkisi. Manisa Celal Bayar Üniversitesi Sosyal Bilimler Dergisi, 22(1), 272-289. https://doi.org/10.18026/cbayarsos.1423629
  4. Bainton, A. (2025). A Quantitative Study Comparing the Effects of Physical and Digital Mandala Coloring on Anxiety in High School Students. https://doi.org/10.33015/dominican.edu/2025.AT.01
  5. Borkakoty, S., Hussain, I., Das, K., Chetia, D., Kalita, K. N., Pathak, K., & Kalita, R. (2019). Perceived stress, sources of stress and coping strategies among undergraduate students at a medical college in Assam. Journal of Dental and Medical Sciences, 18(8), 66-72. https://doi.org/10.9790/0853-1808066672
  6. Bostancıoğlu, B., & Kahraman, M. E. (2017). Sanat Terapisi Yönteminin ve Tekniklerinin Sağlık İyileştirme Gücü Üzerindekİ Etkisi. Beykoz Akademi Dergisi, 5(2), 150-162. https://doi.org/10.14514/BYK.m.21478082.2017.5/2.150-162
  7. Campenni, C. E., & Hartman, A. (2020). The effects of completing mandalas on mood, anxiety, and state mindfulness. Art Therapy, 37(1), 25-33. https://doi.org/10.1080/07421656.2019.1669980
  8. Carsley, D., & Heath, N. L. (2018). Effectiveness of mindfulness-based colouring for test anxiety in adolescents. School Psychology International, 39(3), 251-272.
  9. Chen, M.-J., She, H.-C., & Tsai, P.-Y. (2024). The effects of online simulation-based collaborative problem-solving on students’ problem-solving, communication and collaboration attitudes. Education and Information Technologies., 29(14), 19141-19162.
  10. Cohen, J. (1988). The analysis of variance and covariance (2nd ed.). Lawrence Erlbaum Associates.
  11. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 385-396. https://doi.org/10.2307/2136404
  12. Coşkun, M. V., & Altınkurt, Y. (2016). The relationship between values and critical thinking dispositions of pre-service teachers. Educational Process: International Journal, 5(4), 298. https://doi.org/10.22521/edupij.2016.54.4
  13. Erez, O., Romero, R., Jung, E., Chaemsaithong, P., Bosco, M., Suksai, M., Gallo, D. M., & Gotsch, F. (2022). Preeclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol, 226(2), S786-S803. https://doi.org/10.1016/j.ajog.2021.12.001
  14. Eskin, M., Harlak, H., Demirkıran, F., & Dereboy, Ç. (2013). Algılanan stres ölçeğinin Türkçeye uyarlanması: güvenirlik ve geçerlik analizi. New Symposium Journal,
  15. Fan, X., & Hui, A. N. N. (2025). Academic Stress and Burnout Reduction Through Mandala-Coloring and Grit-Enhancing: School-Based Interventions for Adolescents. Behavioral Sciences, 15(4), 439.
  16. General Directorate of Public Health. (2018). Ministry of Health Emergency Obstetric Care Management Guide. Republic of Türkiye Ministry of Health.
  17. Heppner, P. (1988). The problem solving inventory. Consulting Psychologists Press Palo Alto, CA.
  18. Holt, N. J., Furbert, L., & Sweetingham, E. (2019). Cognitive and affective benefits of coloring: Two randomized controlled crossover studies. Art Ther., 36(4), 200-208. https://doi.org/10.1080/07421656.2019.1645498
  19. Hunter, D. A. (2014). A practical guide to critical thinking: deciding what to do and believe. John Wiley & Sons.
  20. Jaramillo Gómez, D. L., Álvarez Maestre, A. J., Parada Trujillo, A. E., Pérez Fuentes, C. A., Bedoya Ortiz, D. H., & Sanabria Alarcón, R. K. (2025). Determining factors for the development of critical thinking in higher education. Journal of Intelligence., 13(6), 59. https://doi.org/10.3390/jintelligence13060059
  21. Jung, C. G. (2017). Mandala symbolism:(From Vol. 9i collected works). Princeton University Press.
  22. Karabuga Yakar, H., Yılmaz, B., Çelik, E., Özkol, O., Gevher, F., Oruc, Ö., & Şen, H. (2023). The effect of the meditation based mandala programme on distress, anxiety and depression in the caregivers of cancer patients in palliative care unit. OMEGA-Journal of Death and Dying, 87(4), 1361-1374. https://doi.org/10.1177/0030222823118193
  23. Kılıç, H. E., & Şen, A. (2014). Turkish adaptation study of UF/EMI critical thinking disposition instrument. Educational Sciences: Theory & Practice, 39(176). https://doi.org/10.15390/EB.2014.3632
  24. Liu, C., Chen, H., Liu, C.-Y., Lin, R.-T., & Chiou, W.-K. (2020). Cooperative and individual mandala drawing have different effects on mindfulness, spirituality, and subjective well-being. Frontiers in Psychology., 11, 564430. https://doi.org/10.3389/fpsyg.2020.564430
  25. Oğul, S. (2025). Hemodiyaliz Tedavisi Alan Hastalarda Mandala Boyamanın Anksiyete ve Depresyon Üzerine Etkisi [Kafkas Üniversitesi]. Kars.
  26. Olgun, N., Öntürk, Z. K., Karabacak, Ü., Aslan, F. E., & Serbest, Ş. (2010). Hemşirelik öğrencilerinin problem çözme becerileri: bir yıllık izlem sonuçları. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi,(4), 188-194.
  27. Ossa, C. J., Rivas, S. F., & Saiz, C. (2023). Relation between metacognitive strategies, motivation to think, and critical thinking skills. Frontiers in Psychology., 14, 1272958. https://doi.org/10.3389/fpsyg.2023.1272958
  28. Öztürk Can, H., Öner, Ö., & Çelebi, E. (2009). Üniversite öğrencilerinde eğitimin sorun çözme becerisine etkisinin incelenmesi. Fırat Sağlık Hizmetleri Dergisi, 4(10), 35-58.
  29. Quinn, K. (2019). Something is going to happen here: The use of mandala art in enhancing reflective practice. Advances in Nursing Science, 42(3), E1-E19.
  30. Raimaini, N. H. A., & Zahit, R. A. (2023). Exploring Mandala–art as a form of therapy. Trends in Undergraduate Research., 6, e1-7.
  31. Salazar, L. R. (2019). Exploring the effect of coloring mandalas on students’ math anxiety in business statistics courses. Business, Management and Education, 17(2), 134-151.
  32. Shankar, R., & Amir, R. (2020). The effectiveness of mandala colouring therapy in increasing year 3 pupils’ focus during the initial lesson. Creative Education., 11(04), 581-595. https://doi.org/10.4236/ce.2020.114043
  33. Singh, M., & Butola, S. (2024). Correlations between critical thinking and problem-solving skills in critical situations among nursing students. International Journal of Health Sciences Research, 14, 118-124. https://doi.org/10.52403/ijhsr.20240215
  34. Şahin, N., Şahin, N. H., & Heppner, P. P. (1993). Psychometric properties of the problem solving inventory in a group of Turkish university students. Cognitive therapy and research, 17(4), 379-396.
  35. Şişli, B. (2023). Embriyo Transferi Yapılan İnfertil Kadınlara İki Farklı Müzik Eşliğinde Uygulanan Mandala Aktivitesinin Stres Düzeyi ve Stresle Baş Etmeye Etkisi. [İstanbul Okan Üniversitesi]. İstanbul.
  36. Tremblay, M.-L., Lafleur, A., Leppink, J., & Dolmans, D. H. (2017). The simulated clinical environment: cognitive and emotional impact among undergraduates. Medical teacher, 39(2), 181-187. https://doi.org/10.1080/0142159X.2016.1246710
  37. Uysal, N., & Manavoğlu, B. (2019). Hemşirelik öğrencilerinin problem çözme becerilerinin incelenmesi. Sağlık ve Yaşam Bilimleri Dergisi, 1(1), 1-5.
  38. Wang, Q., & Chia, K. H. (2024). Mandala coloring: A therapeutic journey towards affective (emotional) wellness. Asian Journal of Interdisciplinary Research, 7(2), 44-54.
  39. Yunianto, W., Jarvis, D., Lavicza, Z., Putra, Z. H., & El-Bedewy, S. (2025). Primary school students’ problem-solving strategies in creating artworks with GeoGebra: Integrating computational thinking skills into mathematics and visual arts lessons. LUMAT, 13(2), 1-1. https://doi.org/10.31129/LUMAT.13.2.2547
  40. Zhang, M.-Q., Liu, X., & Huang, Y. (2024). Does mandala art improve psychological well-being in patients? A systematic review. Journal of Integrative and Complementary Medicine, 30(1), 25-36. https://doi.org/10.1089/jicm.2022.0780