Puzzle-Based Learning on Nursing Students' Parenteral Medication Knowledge and Motivation (→ PIM-Crosswor)

The Effect of Crossword-Based Learning on Parenteral Drug Administration on Nursing Students' Knowledge Level, Self-Efficacy Perception, and Learning Motivation

This randomized, controlled, parallel-group, interventional study aims to evaluate the effects of Crossword-Based Learning for Parenteral Drug Administration on the knowledge level, self-efficacy perception, and learning motivation of Nursing Department students. It is considered original because it examines the effects of crossword-based learning on cognitive and psychosocial outcomes in parenteral drug administration, a skill with a high risk of error in the clinical field. The study will be conducted with 80 (40 Experimental, 40 Control) nursing students selected through a power analysis. Participants will be assigned to groups by random assignment, and the study will be conducted in accordance with the triple-blind principle (participant, data collector, statistician). The experimental group will receive Crossword Activities in four different phases (Initial, Theoretical, Laboratory, and Post-Clinical Practice) in addition to the standard educational content. The control group will only complete the standard education. The primary outcomes of the study are; At the end of the 4th stage, the Parenteral Drug Administration Knowledge Test will be evaluated based on the Safe Parenteral Drug Administration Self-Efficacy Scale (SES-SES) and the Higher Education Learning Motivation Scale (SLS-SES) scores.

Study Overview

• Status: Not yet recruiting
• Conditions: Nursing Students
• Intervention / Treatment: Behavioral: Puzzle-Based Learning Activity

Detailed Description

Parenteral medication administration is among the fundamental clinical skills of the undergraduate nursing curriculum and is crucial for safe medication management. According to the 2022 National Core Education Program for Nursing (HUÇEP), parenteral medication administration is defined as a mandatory professional competency that nursing students must acquire before graduation (Competency Code: D3). Accordingly, nursing students must integrate their theoretical knowledge of anatomy and pharmacology with technical knowledge and apply it to practice using appropriate methods and techniques in the clinical field. Medication administration is a nursing practice with a high rate of errors in healthcare and can lead to serious clinical consequences that can directly threaten patient safety. Furthermore, this global context also brings with it significant financial losses. According to a report published as part of the World Health Organization (WHO) initiative, "Global Patient Safety Challenge: Medication Without Harm," medication errors account for an annual economic burden of approximately $42 billion. This report does not include specific numerical data on parenteral medication administration; however, it emphasizes that parenteral medication administration carries a higher risk than other routes of administration. Therefore, to minimize the rate of errors resulting from medication errors in general and parenteral medication administration in particular, it is crucial that students possess a strong theoretical foundation, sound psychomotor skills, and a certain level of self-efficacy in their practice. Nursing students' self-efficacy regarding their knowledge and practices regarding medications and medication administration is one of the indicators that nursing education programs have achieved their goals regarding medication administration. In this regard, with the integration of current teaching approaches into nursing education in recent years, game-based learning strategies that make the learning process more active, fun, participatory, and motivating have begun to come to the fore. Among these strategies, crossword puzzles, in particular, are defined as an effective tool for associating complex concepts, learning terminology, increasing knowledge retention, and ensuring student participation. In a randomized controlled study, it was reported that hook and word search puzzles had a statistically significant difference in nursing students' knowledge levels of parenteral drug administration. In another study conducted with nursing students, it was reported that students who used puzzles understood the subject better, felt more competent, and enjoyed the learning process more. Similarly, in the literature, studies conducted with various health sciences students as well as nursing students show that the use of puzzles as an instructional material increases student motivation and interest in the course, makes learning enjoyable, and strengthens retention. However, a review of the literature reveals that studies conducted with the puzzle-based learning approach largely examine the effects on students' knowledge levels. However, two psychosocial factors that are at least as important as knowledge for success in nursing education and clinical practice are self-efficacy perception and motivation to learn. These two concepts support students' intrinsic motivation, increasing their active participation in the learning process, their sense of curiosity, and their willingness to exert effort. A review of the literature reveals no studies evaluating the impact of crossword-based learning activities on parenteral medication administration on nursing students' knowledge, self-efficacy perceptions, and learning motivation. The originality of this study stems from its assessment of not only cognitive gains but also students' psychosocial learning components. Therefore, this study, which is anticipated to contribute to the theoretical and clinical education processes related to parenteral medication administration in nursing, particularly to the nursing literature, aims to evaluate the impact of crossword-based learning activities on nursing students' knowledge, self-efficacy perceptions, and learning motivation.

• Study Type: Interventional
• Enrollment (Estimated): 80
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: FERZAN KALAYCI EMEK, RESEARCH Asistan; Phone Number: +905436540498; Email: ferzan.kalayciemek@ksbu.edu.tr

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Being enrolled as a 2nd-year student in the Nursing Department of the Faculty of Health Sciences at Kütahya Health Sciences University.

• Being registered for the "Fundamental Principles and Practices in Nursing" course.

Exclusion Criteria:

• Not completing the pre-test or post-test data collection forms.

  • Being on medical or academic leave during the study period.
  • Having previously received structured training related to parenteral medication administration within the past 6 months.
  • Participating in another educational intervention study at the same time.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group; Students in the intervention group will receive the structured theoretical lesson content together with a puzzle-based learning activity (çengel bulmaca). The activity is designed to reinforce knowledge, promote active learning, and support concept integration.	Behavioral: Puzzle-Based Learning Activity; A structured puzzle-based (crossword) learning activity developed to reinforce theoretical content on parenteral medication administration. The activity aims to enhance knowledge retention, strengthen concept integration, and promote active engagement among nursing students.
No Intervention: Control Group; Students in the control group will receive only the structured theoretical lesson content without any puzzle-based activity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Knowledge Level Related to Parenteral Medication Administration	Parenteral medication knowledge will be assessed using the Parenteral Medication Knowledge Test developed by the researchers. The test consists of 20 multiple-choice questions covering medication preparation, aseptic technique, administration principles, and clinical decision-making. Each correct answer is scored as 1 point and incorrect answers as 0 points. Total scores range from 0 to 20, with higher scores indicating greater knowledge. The outcome will be evaluated as the change in total scores between measurement time points.	Baseline (Week 0) and after intervention (Week 4)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Learning Motivation (YÖMÖ-Ü)	Change in Learning Motivation (YÖMÖ-Ü): Learning motivation will be assessed using the Motivation for Learning in Higher Education Scale (YÖMÖ-Ü). The scale consists of 26 items rated on a 3-point Likert scale (1 = Disagree, 2 = Neutral, 3 = Agree). Total scores range from 26 to 78, with higher scores indicating higher levels of learning motivation. The outcome will be evaluated as the change in total scores across measurement time points.	Baseline (Week 0), Post-Theoretical Training (Week 2), and Final Assessment (Week 10)
Change in Self-Efficacy Related to Safe Parenteral Medication Administration	Self-efficacy will be assessed using the Safe Parenteral Medication Administration Self-Efficacy Scale (GPİU-ÖYÖ). The scale consists of 76 items rated on a 5-point Likert scale (1 = Strongly disagree to 5 = Strongly agree). Total scores range from 76 to 380, with higher scores indicating greater self-efficacy. The scale evaluates confidence in medication preparation, safe administration practices, error prevention, and clinical decision-making. The outcome will be evaluated as the change in total scores across measurement time points.	Baseline (Week 0) and after clinical practice (Week 10)

Collaborators and Investigators

• Sponsor: Gazi University

Publications and helpful links

General Publications

• Bahar, A., Arslan, M., Gokgoz, N., Ak, H., & Kaya, H. (2017). Do parenteral medication administration skills of nursing students increase with educational video materials? International Journal of Caring Sciences, 10(3), 1514-1525. Turkish Nursing Education Association. (2022). National Core Education Program in Nursing (HUÇEP 2022). https://www.hemed.org.tr/2022-hucep/ Karaahmetoğlu, G. U. (2019). Investigation of nursing students' knowledge levels regarding intramuscular injection practices. Abant Medical Journal, 8(3), 155-161. Foss, K., & Morandini, S. (2023). Using objective structured clinical examination to teach medication rights in undergraduate nursing education. Journal of Professional Nursing, 45, 89-93. https://doi.org/10.1016/j.profnurs.2023.01.007 Kırşan, M., Korhan, E. A., Şimşek, S., Özçiftçi, S., & Ceylan, B. (2019). Medication errors in nursing practices: A systematic review. Turkiye Klinikleri Journal of Nursing Sciences, 11(1). World Health Organization. (2024). Medication without harm: Policy brief. Geneva, Switzerland: WHO. Kelly, S. H., Koharchik, L., Henry, R., Cippel, M., Hardner, S., Kolesar, A., & Clark, B. (2018). An advanced medication administration experience to promote students' knowledge acquisition. Teaching and Learning in Nursing, 13(2), 104-107. Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing students' understanding of medication safety. Nurse Education in Practice, 15(1), 17-21. Zaybak, A., Taşkıran, N., Telli, S., Ergin, E. Y., & Şahin, M. (2017). Nursing students' opinions regarding sufficiency of their drug administration knowledge. Journal of Education and Research in Nursing, 14(1), 6-14. Doğan, S. E., & Aslan, H. (2024). Current teaching methods and techniques used in nursing education. Bingöl University Journal of Health, 5(1), 224-235. Alcindor, M. L. (2022). Application of a crossword puzzle tournament to prepare nursing students for examinations. Nurse Educator, 47(6), E152-E1

Study record dates

Study Major Dates

• Study Start (Estimated): April 28, 2026
• Primary Completion (Estimated): July 15, 2026
• Study Completion (Estimated): September 15, 2026

Study Registration Dates

• First Submitted: November 21, 2025
• First Submitted That Met QC Criteria: April 15, 2026
• First Posted (Actual): April 22, 2026

Study Record Updates

• Last Update Posted (Actual): April 22, 2026
• Last Update Submitted That Met QC Criteria: April 15, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: motivation; self-sufficiency; nursing student; drug administration; Crossword puzzle
• Other Study ID Numbers: GY-HM-FKE-01 (Registry Identifier: Gazi Üniversity)

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