ARCS-Based Escape Room Education and Medication Skills in Nursing Students

Effect of an ARCS-Based Escape Room Education on Nursing Students' IV Medication Administration Skills: A Randomized Controlled Trial

This randomized controlled trial aims to evaluate the effect of an ARCS-based escape room educational intervention on nursing students' medication administration knowledge, clinical skills, and learning motivation. Medication administration errors represent a major threat to patient safety, and nursing students must develop safe medication practices early in their education through effective and engaging instructional approaches.

The study will be conducted with first-year undergraduate nursing students enrolled in a Fundamentals of Nursing course at a public university. Participants will be randomly assigned to either an intervention group or a control group. Both groups will receive standard theoretical instruction and laboratory-based training on medication administration. In addition, the intervention group will participate in an ARCS-based escape room activity designed to reinforce medication administration competencies.

The escape room intervention will be structured according to Keller's ARCS Motivation Model (Attention, Relevance, Confidence, Satisfaction) and will include scenario-based learning stations focusing on oral medication administration and parenteral medication administration operationalized as subcutaneous and intravenous routes. Each station will require students to apply medication safety principles, clinical decision-making, and procedural skills within a time-limited, team-based game environment.

Primary outcomes will include medication administration knowledge and clinical skill performance assessed using a structured knowledge test and objective structured clinical examination (OSCE). Learning motivation will be evaluated as a secondary outcome using a validated motivation scale based on the ARCS model. Assessments will be conducted at baseline and after completion of the educational intervention.

The findings of this study are expected to provide evidence regarding the effectiveness of ARCS-based escape room education as an innovative, student-centered instructional strategy for improving medication administration competencies and learning motivation among nursing students.

Study Overview

• Status: Not yet recruiting
• Conditions: Medication Administration Skills in Nursing Students
• Intervention / Treatment: Behavioral: ARCS-Based Escape Room Education

Detailed Description

Medication administration errors constitute a persistent patient safety concern and are frequently associated with insufficient clinical competence, particularly among novice nursing students. Early development of safe medication administration practices requires instructional approaches that integrate cognitive knowledge, psychomotor skill acquisition, and motivational engagement.

This randomized controlled study is designed to examine the effectiveness of an ARCS-based escape room educational intervention integrated into a Fundamentals of Nursing skills laboratory. The intervention is theory-driven and structured according to Keller's ARCS Motivation Model (Attention, Relevance, Confidence, Satisfaction).

The study will employ a parallel-group randomized design. Following baseline assessment, eligible participants will be allocated to either the intervention or control group using a randomization procedure. Both groups will receive standard curriculum-based theoretical instruction and laboratory practice on medication administration prior to group allocation. The intervention will be implemented as an adjunct educational activity following routine laboratory instruction.

Intervention Structure

The escape room intervention will be delivered as a structured, team-based simulation activity conducted in a controlled laboratory environment. The activity will include sequential scenario-based stations representing simulated patient care contexts. The instructional content will focus on oral medication administration and parenteral medication administration operationalized as subcutaneous and intravenous routes.

Each station will require participants to:

Perform medication safety verification processes (e.g., patient identification, dose confirmation, route verification),

Demonstrate procedural sequencing consistent with standardized medication administration protocols,

Apply clinical reasoning to resolve embedded safety-related challenges,

Collaborate within a time-restricted task structure.

The intervention explicitly operationalizes the ARCS framework:

Attention: Time pressure, interactive puzzles, visual cues, and scenario-triggered challenges.

Relevance: Realistic patient cases reflecting early clinical learning contexts.

Confidence: Progressive task complexity, structured facilitation, and immediate corrective feedback.

Satisfaction: Task completion milestones and structured debriefing following the activity.

The intervention will be delivered once during the laboratory period and will be facilitated by trained faculty members to ensure procedural consistency.

Control Condition

Participants allocated to the control group will continue with routine laboratory-based self-directed skills practice using standard training equipment and demonstration models. No gamified or ARCS-structured activities will be implemented for this group during the study period.

Outcome Assessment Framework

Outcome assessments will be conducted at predefined time points. Knowledge assessment will evaluate cognitive understanding of medication administration principles. Clinical performance will be evaluated using standardized performance-based assessment procedures within a structured examination format. Motivation will be examined as an affective outcome associated with instructional design.

The study is designed to determine whether the integration of a theory-driven, gamified educational strategy produces measurable improvements in medication-related competencies beyond standard laboratory education.

This trial aims to contribute empirical evidence regarding structured motivational instructional design within undergraduate nursing education and its potential implications for strengthening safe medication administration competencies.

• Study Type: Interventional
• Enrollment (Estimated): 110
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Gözde ÖZARAS ÖZ, PhD; Phone Number: +905323495280; Email: gozdeozaras@karatekin.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Being a first-year student Taking the Basic Principles and Practices in Nursing course for the first time Voluntarily participating in the study..

Exclusion Criteria:

Being a graduate of a health vocational high school Not participating in theoretical and laboratory training Not completing data collection forms; and Wanting to withdraw from the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: ARCS-Based Escape Room Education; Nursing students receive an ARCS-based escape room educational intervention designed to improve medication administration skills.	Behavioral: ARCS-Based Escape Room Education; A simulation-based educational intervention structured according to the ARCS motivation model and delivered through an escape room format to enhance medication administration skills.
No Intervention: Standard Education; Nursing students receive standard medication administration education according to the existing curriculum.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intravenous Catheter Insertion Skill Score	Medication administration skill related to intravenous catheter insertion will be assessed using a structured observational checklist (score range: 0-42). Each procedural step is scored dichotomously (0 = not performed/incorrect; 1 = correctly performed). Higher scores indicate better clinical performance.	From baseline to immediately after the intervention
Intravenous Fluid Therapy Initiation Skill Score	Intravenous fluid therapy initiation skills will be assessed using a structured observational checklist (score range: 0-50). Each procedural step is scored dichotomously (0 = not performed/incorrect; 1 = correctly performed). Higher scores indicate better clinical performance.	From baseline to immediately after the intervention
Intravenous Bolus Medication Administration Skill Score	Intravenous bolus medication administration via IV catheter will be assessed using a structured observational checklist (score range: 0-34). Each procedural step is scored dichotomously (0 = not performed/incorrect; 1 = correctly performed). Higher scores indicate better clinical performance.	From baseline to immediately after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motivation Toward Instructional Materials	Motivation will be assessed using the Instructional Materials Motivation Survey (IMMS) based on Keller's ARCS Motivation Model and adapted into Turkish by researchers. The scale consists of 33 items rated on a 5-point Likert scale. Total scores range from 33 to 165. Higher scores indicate higher levels of learning motivation toward the instructional material.	From baseline to immediately after the intervention

Collaborators and Investigators

• Sponsor: Gözde ÖZARAS ÖZ

Study record dates

Study Major Dates

• Study Start (Estimated): February 1, 2026
• Primary Completion (Estimated): March 1, 2026
• Study Completion (Estimated): April 1, 2026

Study Registration Dates

• First Submitted: February 7, 2026
• First Submitted That Met QC Criteria: February 7, 2026
• First Posted (Actual): February 13, 2026

Study Record Updates

• Last Update Posted (Actual): February 19, 2026
• Last Update Submitted That Met QC Criteria: February 18, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Randomized controlled trial; Nursing students; Medication administration; Escape room education; ARCS motivation model
• Other Study ID Numbers: ARCS-ER-MED-2026

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared outside the research team due to ethical considerations, institutional policies, and the nature of the educational intervention involving a limited student population.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No