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

Overview

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.

Medication administration errors remain a significant patient safety concern in healthcare settings, particularly among novice nursing students who are still developing foundational clinical competencies. Ensuring that nursing students acquire safe medication administration knowledge, procedural skills, and learning motivation early in their education is essential for reducing preventable errors in clinical practice. Traditional teaching methods, which often rely on didactic lectures and demonstration-based laboratory instruction, may be insufficient to sustain student engagement and facilitate the transfer of learning to clinical environments. In recent years, gamified and simulation-based instructional strategies have gained attention in nursing education as innovative approaches to promote active learning, clinical reasoning, and learner motivation. Escape room-based education is a form of game-based learning that integrates problem-solving, teamwork, time pressure, and scenario-based challenges within a structured learning environment. When grounded in a theoretical motivational framework, escape room interventions may enhance both cognitive and affective learning outcomes. This randomized controlled trial is designed to evaluate the effectiveness of an escape room educational intervention structured according to Keller's ARCS Motivation Model (Attention, Relevance, Confidence, Satisfaction). The intervention aims to improve nursing students' medication administration knowledge, clinical skill performance, and learning motivation compared with standard laboratory-based education alone. The study will be conducted with first-year undergraduate nursing students enrolled in a Fundamentals of Nursing course at a public university. All participants will receive standard theoretical instruction and laboratory practice related to medication administration as part of the existing curriculum. Following baseline assessments, participants will be randomly assigned to either the intervention group or the control group. Students in the intervention group will participate in a one-time ARCS-based escape room activity designed to reinforce foundational medication administration competencies. The escape room will consist of multiple scenario-based learning stations, each representing a simulated patient care environment. The instructional content will focus on oral medication administration and parenteral medication administration operationalized as subcutaneous and intravenous routes. These routes were selected to ensure comparable cognitive and psychomotor demands, consistent procedural flow, and alignment with medication safety principles, including patient identification, dose verification, route accuracy, and post-administration monitoring. The escape room design will explicitly incorporate the four components of the ARCS Motivation Model. The Attention component will be addressed through time-limited challenges, puzzles, visual and auditory cues, and competitive elements embedded within the game structure. Relevance will be supported by realistic clinical scenarios that reflect medication administration situations commonly encountered by novice nursing students. Confidence will be fostered through structured task progression, teamwork, facilitator guidance, and immediate feedback during gameplay. Satisfaction will be promoted through successful task completion, unlocking of sequential challenges, and a structured debriefing session following the activity. The control group will not participate in the escape room intervention. Instead, control group students will engage in self-directed laboratory practice using standard equipment and models, consistent with routine skills laboratory activities. No additional gamified or motivational instructional strategies will be provided to the control group during the study period. Outcome assessments will be conducted at baseline and after completion of the educational intervention. Medication administration knowledge will be evaluated using a structured knowledge test developed in accordance with relevant nursing education literature. Clinical skill performance will be assessed through an objective structured clinical examination (OSCE) using standardized checklists corresponding to oral, subcutaneous, and intravenous medication administration procedures. Learning motivation will be measured as a secondary outcome using a validated motivation scale based on the ARCS model. This study seeks to generate evidence regarding the effectiveness of ARCS-based escape room education as a student-centered, theory-driven instructional approach in undergraduate nursing education. The findings are expected to inform the development of innovative educational strategies aimed at strengthening medication administration competencies, enhancing learner motivation, and ultimately contributing to improved patient safety outcomes.