Current medical education literature emphasises the use of active learning and teamwork as an effective method to teach and engage learners. The jigsaw method, employed since 1970s, has proven to be effective in high school and college education. In this strategy members of the class are organised into groups and then rearranged into new groups to share their learning through peer teaching. Traditional pedagogical techniques are still very much the norm within higher education.

Student learning remains largely based upon extracting knowledge from texts and lectures. This style of teaching rarely allows students to apply their newfound knowledge to actual situations, resulting in a serious time lag between students learning and applying new knowledge. It is attributed to simulations and relates to the suggested improvements in overall student learning. Because much of the literature has stressed the increased levels of cognitive learning, it has the power to recreate complex, dynamic political processes in the lecture, allowing students to examine the motivations, behavioural constraints, resources and interactions among institutional actors (Konar, 2015). It was designed by social psychologist Elliot Aronson to help weaken racial cliques in forcibly integrated schools. A study by John Hattie found that the jigsaw method benefits students’ learning (Jacob, 2015).

Objectives
The study was conducted with following objectives:

1. To assess the existing level of knowledge on the mechanism of labour among nursing students.
2. To determine if the traditional didactic lecture or the jigsaw learning method is more effective in teaching the mechanism of labour.
3. To introduce and implement the Jigsaw Puzzle method.
4. To assess the effectiveness of the Jigsaw puzzle method and compare it with the traditional method.

Methodology
For the present study, cross cross-sectional design with pre-test / post-test method was adopted; it was comparative in nature. Respondents were from three selected nursing colleges of Bengaluru, viz Global College of Nursing, Brite College of Nursing and Avk College of Nursing. The students meeting the inclusion criteria of constituted the sample. The sample size consisted of 500 BSc (N) 4th year, and 3rd year GNM students.

Data Collection Method
Stage1: Using the random method 250 respondents were selected for the traditional, and as many respondents for the jigsaw method, one setting one method.
Stage 2: Administered the socio-demographic data sheet, 20 structured points to both groups.
Stage 3: Jigsaw technique was introduced to 250 samples and the traditional teaching method to 250 samples.
Stage 4: A quiz was conducted after one week for the Jigsaw group and same day for the traditional group after the traditional class lecture.

Jigsaw Technique
Step1 - The sample is divided into 10 ‘Expert Groups’ with 25 samples in each;
Step 2 - One sample in each group who has a sound academic performance is appointed as the group leader to lead the group;
Step 3: The concepts of the mechanism of labour are divided into 10 different segments, like labour preparation - Causes of the onset of labour; Phases of labour; False labour pain and true labour pain; Physiological changes during labour; Stages of labour; Physiology of the first stage of labour; Physiology of the second stage of labour; Mechanism of normal labour; Physiology of the third stage of labour;
Step 4: Each student in the expert group has to learn about different topics related to the Mechanism of labour. The group is instructed to prepare the topic well, read it well, do extra reading than textual notes, but at the same time to prepare something simple enough to teach as well as make other students learn faster. The assigned students are expected to shoulder the responsibility of preparing that topic well.
Step 5: Students are instructed not to memorise, but instead to prepare with understanding. A day was fixed to organise the Jigsaw classroom. Students initially can discuss their topics in their parent groups. Each student explains and presents their prepared topic.
Step 6: The students with similar topics made a group and discussed their topics. Each student had to share their acquired knowledge on their topics. The others noted down additional points.
Step 7: Students then returned to their expert groups and once again shared their topics, having motivations, behavioural constraints, resources and interactions among institutional actors (Konar, 2015). It was designed by social psychologist Elliot Aronson to help weaken racial cliques in forcibly integrated schools. A study by John Hattie found that the jigsaw method benefits students’ learning (Jacob, 2015). 

Objectives
The study was conducted with following objectives:
1. To assess the existing level of knowledge on the mechanism of labour among nursing students.
2. To determine if the traditional didactic lecture or the jigsaw learning method is more effective in teaching the mechanism of labour.
3. To introduce and implement the Jigsaw Puzzle method.
4. To assess the effectiveness of the Jigsaw puzzle method and compare it with the traditional method.

Methodology
For the present study, cross cross-sectional design with pre-test / post-test method was adopted; it was comparative in nature. Respondents were from three selected nursing colleges of Bengaluru, viz Global College of Nursing, Brite College of Nursing and Avk College of Nursing. The students meeting the inclusion criteria of constituted the sample. The sample size consisted of 500 BSc (N) 4th year, and 3rd year GNM students.

Data Collection Method
Stage1: Using the random method 250 respondents were selected for the traditional, and as many respondents for the jigsaw method, one setting one method.
Stage 2: Administered the socio-demographic data sheet, 20 structured points to both groups.
Stage 3: Jigsaw technique was introduced to 250 samples and the traditional teaching method to 250 samples.
Stage 4: A quiz was conducted after one week for the Jigsaw group and same day for the traditional group after the traditional class lecture.

Jigsaw Technique
Step1 - The sample is divided into 10 ‘Expert Groups’ with 25 samples in each;
Step 2 - One sample in each group who has a sound academic performance is appointed as the group leader to lead the group;
Step 3: The concepts of the mechanism of labour are divided into 10 different segments, like labour preparation - Causes of the onset of labour; Phases of labour; False labour pain and true labour pain; Physiological changes during labour; Stages of labour; Physiology of the first stage of labour; Physiology of the second stage of labour; Mechanism of normal labour; Physiology of the third stage of labour;
Step 4: Each student in the expert group has to learn about different topics related to the Mechanism of labour. The group is instructed to prepare the topic well, read it well, do extra reading than textual notes, but at the same time to prepare something simple enough to teach as well as make other students learn faster. The assigned students are expected to shoulder the responsibility of preparing that topic well.
Step 5: Students are instructed not to memorise, but instead to prepare with understanding. A day was fixed to organise the Jigsaw classroom. Students initially can discuss their topics in their parent groups. Each student explains and presents their prepared topic.
Step 6: The students with similar topics made a group and discussed their topics. Each student had to share their acquired knowledge on their topics. The others noted down additional points.
Step 7: Students then returned to their expert groups and once again shared their topics, having new points. The investigator has floated between groups and facilitated the whole process.
Step 8: The Jigsaw group were assessed using the 20 structured points related to the mechanism of labour through a quiz after a week of going through the Jigsaw method.

Traditional Class Lecture
Step 1: Traditional lecture-cum-demonstration of the mechanism of labour for 250 samples.
Step2: Conducted a quiz on the same day for the traditional group after the traditional class lecture

In the jigsaw group, 181 (72.4%) students were in the age of 20 years, 43 (17.2%) were in the age of 21 years, 26 (10.4%) were in the age of 22 years, 0 (0.0%) in the age of 23 years (Table 1). In the traditional group, 49 (19.6%) were in the age of 20 years, 146 (58.4%) the age of 21 years, 48 (19.2%) were in the age of 22 years, and 7 (2.8%) were in the age of 23 years. In relation to residence for the group, 251 (50.2%) stay in urban areas, 216 (43.2%) belong to urban areas, and 23 (4.6%) others. Considering the type of family for both the group, 138 (27.6%) belong to joint family, 183 (36.6%) to extended family, and 179 (35.8%) to nuclear family.

Table 2 revealed that for mother, jigsaw group had 33 (13.2%) secondary education, 0 (0.0%) high school education, 124 (49.6%) primary education, 93 (37.2%) no education, traditional group had 24 (9.6%) secondary education, 12 (4.8%) high school education, 165 (66.0%) primary education, 49 (19.6%) no education. For father, jigsaw group had 153 (61.2%) secondary education, 77 (30.8%) primary education and 0 (0.0%) high school education, 20 (8.0%) no education. Traditional group had 20 (8.0%) high school education, 25 (10.0%) secondary education 14 (5.6%) primary and 191 (76.4%) no education.

Table 3 revealed that for father’s occupation, the jigsaw group had 165 (66%) homemakers, 62 (24.8%) business, 23 (9.2%) private. Traditional group had 33 (13.2%) home maker, 49 (19.6%) business, 136 (54.4%) private, 32 (12.8%) government. For mother’s occupation, jigsaw group had 48 (19.2%) home maker, 59 (23.6%) business, 143 (57.2%) private. The traditional group had 207 (82.8%) homemakers, 13 (5.2%) business, 14 (5.6%) private,16 (6.4%) government.

As for monthly income, for jigsaw group, 162 (64%) having income of above Rs 5,000-10000, 51 (20.4%) had Rs 110,00 to 14,000, 37 (14.8%) had Rs 15000 to 20000. In traditional group, 40 (16%) had income above Rs 5,000-10000, 168 (67.2%) had Rs 110,00 to 14,000, 42 (16.8%) Rs 15000 to 20000. About food habits, in the jigsaw group, 34 (13.6%) were vegetarian, 42 (16.8%) non-vegetarian, 174 (69.6%) mixed diet. In traditional group, 46 (18.4%) were vegetarian 3 (1.2%) non- vegetarian, 201 (80.4%) mixed diet. About extracurricular activities, in Jigsaw group, 41 (16.4%) were sports, 67 (26.8%) dance, and 42 (16.8%) others. In traditional group, 67 (26.8%) were sports 23 (9.2%) dances,160 (64%) others.

The distribution of knowledge level among students revealed (Table 5) that in the pre-test, in the Jigsaw group, the majority of the respondents (n=107, 42.8%), had inadequate, 143 (57.2%) had moderate, and in the traditional group majority of the respondents (n=126, 50.4%), had inadequate, and 124 (49.6%) had moderate knowledge.

The distribution of post-test knowledge level among students showed that in the jigsaw group the majority of the respondents (n=83, 33.2%) had moderate knowledge, 167 (66.8). In the traditional group majority of the respondents, 105 (42.0%) had moderate, 145 (58.0%) had adequate knowledge (Table 6).

Table 7 reveals that there was a significant association between pre-test scores of students grade and learning experience among Jigsaw learning method with age group, type of family, father’s occupation, mother’s occupation, family income, food habits, extracurricular activities whereas there was no significant association between pre-test scores of students grade and learning experience among Jigsaw learning method with mother’s education, religion.

As Table 8 reveals, there was a significant association between pre-test scores of students grade and learning experience among traditional method with age group, type of family, father’s occupation, mother’s occupation, family income, food habits, extracurricular activities whereas there was no significant association between pre-test scores of students grade and learning experience among traditional method with father’s education and religion education and training to upgrade their knowledge and skills.

References

1. Marlow DR, Redding BA. Marlow’s textbook of pediatric Nursing. 6th edn 2013. Reed Elsevier India Private Limited: New Delhi; p 928

2. Elizabeth M. Midwifery for Nurses. 2nd edn 2019. CBS Publishers and distributors Private Limited: New Delhi; p33

3. Konar H. D C Dutta’s Textbook of Midwifery and Gynecological Nursing. 4th edn 2015. Jaypee Brothers Publishers: New Delhi; pp 146- 47

4. Jacob A. Comprehensive Textbook of Midwifery and Gynecological Nursing. 4th edn 2015. Jaypee Brothers Publishers: New Delhi; p 996