Effect of Word Search and Case-Based Puzzle Use in Stoma Care Education of Nursing Students (PUZZLE-STOMA)

The Effect of Using Word Searches and Case-Based Puzzles in Stoma Care Education for Nursing Students

Objective: This study aims to determine the effect of using word search and case-based puzzles in stoma care education on nursing students' knowledge levels. Given that traditional teaching methods may have limited effectiveness in helping students acquire knowledge and skills, the study aims to demonstrate the contribution of integrating active learning and gamification-based approaches into education.

Design: The study is planned as a randomized controlled experimental design and will use a pre-test-post-test measurement approach.

Method: The study will be conducted with second-year students from the Nursing Department at Gazi University. This research will be prepared under the guidance of the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) protocol, and the reporting of the randomized controlled study will be carried out under the Consolidated Standards of Reporting Trials (CONSORT). In the study, students will be randomly assigned to the experimental and control groups. The experimental group will receive training that includes word search and case-based puzzles during the stoma care training process, while the control group will receive training using traditional teaching methods. Students' knowledge levels will be assessed with measurements applied before and after the training, and student opinions regarding the training method will also be analyzed. The "Stoma Care Knowledge Level Assessment Test" will be used to evaluate knowledge levels, and the "Student Opinions on the Use of Puzzles and Word Searches in Stoma Education" form will be used to determine student opinions.

Hypothesis: The null hypothesis (H0) of the study states that the use of word search and case-based puzzles in stoma care education has no effect on students' knowledge level; the alternative hypothesis (H1) states that this educational method significantly affects students' knowledge level.

Study Overview

• Status: Not yet recruiting
• Conditions: Nursing Education; Ostomy; Stoma Care Education in Nursing Students
• Intervention / Treatment: Other: Puzzle-Based Learning Intervention; Other: Traditional Education

• Study Type: Interventional
• Enrollment (Estimated): 87
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Zeynep Mete Merdin; Phone Number: +905066979094; Email: zeynmete@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Nursing students enrolled in the Surgical Nursing course for the first time,
• Students who voluntarily agree to participate in the study.

Exclusion Criteria:

• Students who have previously received stoma care training through another educational platform,
• Students who provide incomplete responses to data collection forms,
• Students who do not attend the theoretical course sessions,
• Students who do not participate in any stage of the knowledge assessment,
• Students who do not complete puzzle and word search activities included in the intervention.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PUZZLE-STOMA; Participants receive stoma care education supported by word search activities and case-based puzzle exercises designed to enhance knowledge acquisition and active learning.	Other: Puzzle-Based Learning Intervention; Stoma care education supported by word search and case-based puzzle activities aimed at improving students' knowledge and engagement in learning.
Active Comparator: Control Group; Participants receive conventional stoma care education using standard lecture-based teaching methods without puzzle or game-based learning activities.	Other: Traditional Education; Standard stoma care education delivered through traditional lecture-based instruction.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stoma Care Knowledge Level Assessment Test	This test consists of 24 questions prepared based on relevant literature on stoma care. The test is scored on a scale of 0 to 100, with higher scores indicating higher levels of knowledge. It is administered before and immediately after the educational intervention and again at the fourth week after the intervention for follow-up assessment.	Before the intervention, immediately after the intervention, and 4 weeks after the intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Students' Opinions on the Use of Puzzle and Word Search Activities in Stoma Education	This evaluation form was developed based on relevant literature to assess students' opinions regarding the use of case-based puzzles and word search activities in stoma care education. The form consists of seven questions, including two open-ended items, addressing knowledge acquisition, reinforcement of learning, development of critical thinking skills, and willingness to recommend the method. Responses will be scored using a Visual Analog Scale (VAS)	Immediately post-intervention

Collaborators and Investigators

• Sponsor: Gazi University

Publications and helpful links

General Publications

• Kaynak, S., Ergün, S., & Karadaş, A. (2023). The effect of crossword puzzle activity used in distance education on nursing students' problem-solving and clinical decision-making skills: A comparative study. Nurse Education in Practice, 69, 103618.
• EYÜBOĞLU, G., BULDAN, Ö., SARITAŞ, E., & BAYKARA, Z. G. (2025). The Effect of Crossword and Word Search Puzzles on Nursing Students' Parenteral Medication Administration Knowledge: A Randomized Controlled Study. Turkiye Klinikleri Journal of Nursing Sciences, 17(1), 154-162.
• Li, S., Ye, X., & Chen, W. (2019). Practice and effectiveness of "nursing case-based learning" course on nursing student's critical thinking ability: A comparative study. Nurse education in practice, 36, 91-96.
• Gholami, M., Changaee, F., Karami, K., Shahsavaripour, Z., Veiskaramian, A., & Birjandi, M. (2021). Effects of multiepisode case-based learning (CBL) on problem-solving ability and learning motivation of nursing students in an emergency care course. Journal of Professional Nursing, 37(3), 612-619.
• Yao J, Zhang X, Xue H, Zhu M, Wang J, Wang Q, Chen Z, Yuan H. The experiences of nursing master's students with dialogic case-based learning in an evidence-based nursing course: A qualitative study. Nurse Educ Today. 2022 Jul;114:105395. doi: 10.1016/j.nedt.2022.105395. Epub 2022 May 9. PMID: 35567909

Study record dates

Study Major Dates

• Study Start (Estimated): February 16, 2026
• Primary Completion (Estimated): February 19, 2026
• Study Completion (Estimated): March 19, 2026

Study Registration Dates

• First Submitted: February 13, 2026
• First Submitted That Met QC Criteria: February 13, 2026
• First Posted (Actual): February 20, 2026

Study Record Updates

• Last Update Posted (Actual): February 20, 2026
• Last Update Submitted That Met QC Criteria: February 13, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: stoma care; Nursing Education; Case-Based Learning; Puzzle-Based Learning
• Other Study ID Numbers: 21853602011

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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