The Effect of an ARCS Model-Based Escape Room Simulation on Nursing Students' Knowledge, Motivation, and Self-Efficacy Regarding Surgical Site Infections

The study is designed as a randomized controlled trial with an experimental and control group, using a pre-test, post-test, and follow-up test design.

All students who agreed to participate in the study will complete the "Demographic Information Form," the "Knowledge Test on the Prevention of Surgical Site Infections (pre-test)," the "Teaching Material Motivation Scale (pre-test)," and the "Nursing Students' Academic Self-Efficacy Scale (pre-test)." Students will be assigned to the experimental and control groups using simple randomization based on their scores on the Surgical Site Infections Prevention Knowledge Test.

Students in the experimental group will be briefed on the topic of Surgical Site Infections (CAE) prevention by the researcher. Following the training, an escape room simulation designed according to the ARSC Motivation Model will be conducted. Each escape room simulation will be conducted with 6 students and will consist of a pre-briefing session, the escape room simulation activity, and a debriefing session. During the pre-briefing session, the simulation objectives, the purpose of the scenario, the roles within the scenario, and the game rules will be explained, and the escape room and the standard patient will be briefly introduced to the students in the meeting room. Following this, the students will carry out the scenario and game activities (KAHOOT, Board Game, Card Game, Word Cloud, Crossword Puzzle) in the simulation laboratory, which has been set up as an escape room, accompanied by a standard patient. The researcher will serve as a facilitator during the escape room simulation. If the expected steps are not performed correctly or the game activity is not successfully completed during the session, the team has the right to request a hint from the facilitator. Immediately after the escape room simulation is completed, a debriefing session will be held. The debriefing session, lasting approximately 20-30 minutes per team, will take place in the meeting room located directly across from the escape room. During the debriefing session, students will be encouraged to express their feelings and thoughts, and the researcher will provide feedback.

All students in the control group will receive instruction on the topic of Surgical Site Infection prevention using the traditional teaching method by the researcher.

After the training is completed and 1. month, all students will be administered the "Surgical Site Infection Prevention Knowledge Test (post-test)," the "Teaching Material Motivation Scale (post-test)," and the "Nursing Students' Academic Self-Efficacy Scale (post-test)." Research Questions Does an ARCS-model-based escape room simulation increase nursing students' knowledge levels regarding surgical site infections? Does an ARCS-model-based escape room simulation increase nursing students' learning motivation regarding surgical site infections? Does an ARCS-model-based escape room simulation increase nursing students' self-efficacy regarding surgical site infections?

Study Overview

• Status: Not yet recruiting
• Conditions: Surgical Site Infections; ARSC Motivation Model; Escape Room Simulation
• Intervention / Treatment: Other: Escape Room Simulation

Detailed Description

Supporting learning motivation is of great importance when implementing innovative learning approaches in nursing education. The ARCS model, which is among the models that help students become more active in the learning process by increasing their motivation, consists of four components: Attention, Relevance, Confidence, and Satisfaction. The Attention component involves determining how attention is managed and directed, and channeling it toward appropriate stimuli. The Relevance component focuses on how the learner's needs are met to foster a positive attitude. To increase interest in the learning process, connections can be made with prior experiences. The confidence component involves instilling belief in the learner's ability to succeed. The satisfaction component, meanwhile, concerns how the learner's success is supported through internal and external rewards. It increases students' learning motivation, enhances their self-efficacy, makes learning more enduring, and strengthens critical thinking skills. The literature indicates that while studies using the ARCS model in nursing education were limited in the past, they have been rapidly increasing in recent times.

Escape room simulations, which are among the innovative learning methods in nursing education, have been shown to enhance students' clinical decision-making, communication, teamwork, and problem-solving skills, and studies on this topic in the literature are rapidly increasing. It is believed that implementing the escape room simulation under the guidance of the ARCS model can support students' learning motivation and thereby enhance the quality of education. Surgical site infection (SSI) is defined as infections occurring at the incision site, organ, or cavity following a surgical procedure. SSI prolongs the patient's hospital stay and delays the recovery process. In addition to these, it leads to complications and increases the mortality rate. It also results in increased costs for the hospital. Nursing education plays a significant role in preventing SSI and accelerating the recovery process by ensuring continuity of care. No study has been found in the literature examining the application of an escape room simulation based on the ARCS model on nursing students. Accordingly, it is anticipated that escape room simulations based on the ARCS model will enhance nursing students' knowledge regarding surgical site infections, as well as their learning motivation and self-efficacy levels.

Materials and Methods The research was planned as a randomized controlled trial.

Hypotheses:

H1: An escape room simulation based on the ARCS model increases nursing students' knowledge levels regarding surgical site infections.

H2: An ARCS-model-based escape room simulation increases nursing students' motivation to learn about surgical site infections.

H3: An ARCS-model-based escape room simulation increases nursing students' self-efficacy regarding surgical site infections.

Study Location and Characteristics This research will be conducted with students of the Nursing Department of Başkent University Faculty of Health Sciences between May 01, 2026 and June 30, 2026. The research will be conducted in the Professional Skills Laboratory of Başkent University Faculty of Health Sciences.

Research Population and Sample The study population will consist of 85 second-year students. The study sample will consist of students who meet the inclusion criteria and do not meet the exclusion criteria.

Inclusion criteria for the study:

• Being a nursing undergraduate student
• Voluntarily agreeing to participate in the study

Exclusion criteria for the study:

• Being a graduate of any health sciences program
• Having prior experience with an escape room simulation

Data to be excluded:

• Students who do not complete the research process for any reason will be excluded from the study.

Within the scope of the "Differentiation and Care in Health Conditions 1" course, the topic of surgical site infections is covered theoretically over two class hours in the second year. The theoretical content of the courses is presented by faculty members using lecture, question-and-answer, and discussion methods.

Randomization Students will be assigned to experimental and control groups using a simple randomization method based on their average scores on a knowledge test regarding the prevention of surgical site infections. A power analysis was conducted to determine the study's sample size. A power analysis was conducted to determine the study's sample size. The G-Power 3.1.9.7 statistical software was used to calculate the study's sample size. The power analysis determined that the study must be conducted with a total of 54 students, with at least 27 students in the experimental group and 27 in the control group. Taking data loss into account, the sample size was increased by 10%, aiming to reach 60 students.

Data Collection Tools The data for the study will be collected using the "Demographic Information Form," the "CAE Prevention Knowledge Test," the "Teaching Materials Motivation Scale," and the "Nursing Students' Academic General Self-Efficacy Scale." Demographic Characteristics Form; this form was prepared by the researchers. The form consists of 4 questions regarding the students' demographic characteristics (age, gender, frequency of computer use, frequency of smartphone use) CAE Prevention Knowledge Test (pre-test-post-test); A questionnaire developed by the researcher based on the literature will be used to assess nurses' knowledge regarding the prevention of surgical site infections. The form was reviewed by 7 experts and finalized.

Teaching Materials Motivation Scale; This scale is structured based on the ARCS motivation model developed by Keller (2009) and adapted into Turkish by Dinçer and Doğanay (2016). The scale consists of a total of 33 items and four subscales (Attention, Level of Interest, Confidence, and Satisfaction).

The scale's Cronbach's alpha values are reported as 0.96 overall, 0.89 for attention, 0.81 for level of interest, 0.90 for confidence, and 0.92 for satisfaction. The scale is evaluated using a 5-point Likert-type scale, and the total score range is 33-165; higher scores are interpreted as indicating higher motivation. The lower and upper score ranges are classified as very low (33-37) and very high (161-165), respectively.

Academic Nurse Self-Efficacy Scale (ANSEs):

Developed by Bulfone et al. (2019) to assess the academic self-efficacy of nursing students at the undergraduate level, and validated and reliability-tested in Turkish by Aktay and Çiçek Korkmaz (2023), the scale consists of 14 items and four subscales. The scale includes internal emotion regulation (items 1, 2, 3), self-control behavior (items 4, 5, 6, 7), external emotion regulation (items 8, 9, 10, 11), and sociability (items 12, 13, 14). The items on this scale are scored on a 1-5 scale, and the question "How much do you trust yourself?" is scored using a 5-point Likert scale (1 = I do not trust myself at all, 5 = I trust myself very much). As the scores on the scale increase, nursing students' academic self-efficacy also increases. The scale does not contain any reverse-scored items. The Cronbach's alpha value of the original scale is 0.84, and in this study, it is 0.82.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tuba Yilmazer, PhD; Phone Number: 5079552804; Email: tyilmazer@aybu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Ankara Yildirim Beyazit University
    • Contact: Tuba Yilmazer, PhD; Phone Number: 05079552804; Email: tyilmazer@aybu.edu.tr

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Being a nursing undergraduate student
• Voluntarily agreeing to participate in the study

Exclusion Criteria:

• Being a graduate of any health sciences program
• Having prior experience with an escape room simulation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental; All students who agree to participate in the study will be administered the "Demographic Information Form," the "CAE Prevention Knowledge Test (pre-test)," the "Teaching Material Motivation Scale (pre-test)," and the "Nursing Students' Academic Self-Efficacy Scale (pre-test)." Students in the experimental group will receive instruction on CAE prevention from the researcher. Following the training, an escape room simulation designed according to the ARSC Motivation Model will be conducted. Each escape room simulation will be conducted with 6 students and will consist of a pre-briefing session, the escape room simulation activity, and a debriefing session. During the pre-briefing session, the simulation objectives, the purpose of the scenario, the roles within the scenario, and the game rules will be explained, and the escape room and the standard patient will be briefly introduced to the students in the meeting room. Following this, the students will carry out the scenario and game ac	Other: Escape Room Simulation; Students in the experimental group will receive instruction on CAE prevention from the researcher. Following the training, an escape room simulation designed according to the ARSC Motivation Model will be conducted. Each escape room simulation will be conducted with 6 students and will consist of a pre-briefing session, the escape room simulation activity, and a debriefing session. During the pre-briefing session, the simulation objectives, the purpose of the scenario, the roles within the scenario, and the game rules will be explained, and the escape room and the standard patient will be briefly introduced to the students in the meeting room. Following this, the students will carry out the scenario and game activities (KAHOOT, Board Game, Card Game, Word Cloud, Crossword Puzzle) in the simulation laboratory, which has been set up as an escape room, accompanied by a standard patient. The researcher will serve as a facilitator during the escape room simulation. If the expected steps are
No Intervention: Control; All students who agree to participate in the study will be administered the "Demographic Information Form," the "CAE Prevention Knowledge Test (pre-test)," the "Teaching Material Motivation Scale (pre-test)," and the "Nursing Students' Academic Self-Efficacy Scale (pre-test)." All students in the control group will receive instruction on the CAE prevention topic using traditional teaching methods provided by the researcher. After the training is completed and at the end of the first month, all students will be administered the "CAE Prevention Knowledge Test (post-test)," "Teaching Material Motivation Scale (post-test)," and "Nursing Students' Academic Self-Efficacy Scale (post-test)."

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CAE Prevention Knowledge Test (pre-test-post-test)	A questionnaire developed by the researcher based on the literature will be used to assess nurses' knowledge regarding the prevention of surgical site infections. The form was reviewed by 7 experts and finalized.	Day 1 (pre-education), Day 1 (post-education) and Day 30 (post-education)
Teaching Materials Motivation Scale	This scale is structured based on the ARCS motivation model developed by Keller (2009) and adapted into Turkish by Dinçer and Doğanay (2016). The scale consists of a total of 33 items and four subscales (Attention, Level of Interest, Confidence, and Satisfaction). The scale's Cronbach's alpha values are reported as 0.96 overall, 0.89 for attention, 0.81 for interest level, 0.90 for confidence, and 0.92 for satisfaction. The scale is assessed using a 5-point Likert-type scale, and the total score range is 33-165; higher scores are interpreted as indicating higher motivation. The lower and upper score ranges are classified as very low (33-37) and very high (161-165), respectively.	Day 1 (pre-education), Day 1 (post-education) and Day 30 (post-education)
Academic Nurse Self-Efficacy Scale (ANSEs)	developed by Bulfone et al. (2019) to assess the academic self-efficacy of nursing students at the undergraduate level, and for which Aktay and Çiçek Korkmaz (2023) conducted a validity and reliability study in Turkish, the scale consists of 14 items and four subscales. The scale includes internal emotion regulation (items 1, 2, 3), self-control behavior (items 4, 5, 6, 7), external emotion regulation (items 8, 9, 10, 11), and sociability (items 12, 13, 14). The items on this scale are scored on a 1-5 scale, and the question "How much do you trust yourself?" is scored using a 5-point Likert scale (1 = I do not trust myself at all, 5 = I trust myself very much). As the scores on the scale increase, nursing students' academic self-efficacy also increases. The scale does not contain any reverse-scored items. The Cronbach's alpha value of the original scale is 0.84, and in this study, it is 0.82.	Day 1 (pre-education), Day 1 (post-education) and Day 30 (post-education)
Demographic Information Form	this form was prepared by the researchers. The form consists of 4 questions regarding the students' demographic characteristics (age, gender, frequency of computer use, frequency of smartphone use) (age in years; frequency of computer and smartphone use in hours).	Day 1 (pre-education), Day 1 (post-education) and Day 30 (post-education)

Collaborators and Investigators

• Sponsor: Ankara Yildirim Beyazıt University

Study record dates

Study Major Dates

• Study Start (Estimated): May 1, 2026
• Primary Completion (Estimated): June 30, 2026
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: April 15, 2026
• First Submitted That Met QC Criteria: April 20, 2026
• First Posted (Actual): April 27, 2026

Study Record Updates

• Last Update Posted (Actual): April 27, 2026
• Last Update Submitted That Met QC Criteria: April 20, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Postoperative Complications; Pathologic Processes; Infections; Wound Infection; Pathological Conditions, Signs and Symptoms; Surgical Wound Infection
• Other Study ID Numbers: ARCSEscapeRoom

Drug and device information, study documents

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