Nursing students must learn a variety of concepts and professional skills during their education. This learning process can be challenging, and reinforcement is often necessary. To support students and enhance their interest, it is recommended to implement active learning strategies. One effective strategy is the use of puzzles. The purpose of this study was to examine the effect of puzzles on nursing students' learning concepts and skills related to administering medication via intramuscular injection.
This study were conducted a randomized controlled experimental design incorporating pre-test and post-test follow-ups. The study sample consisted of volunteer nursing students at the nursing department of a university in western Turkey. In this department, an internship program is offered and the Fundamentals of Nursing course. Drug Administration Unit is designed to provide 15 hours of theoretical instruction and 40 hours of practical training during the spring semester in Fundamentals of Nursing course. For the IM application, 5 hours of theory and 16 hours of practice were used from the 15 hours of theoretical lectures and 40 hours of practical training. Students were informed of the purpose of the study and their consent was obtained. Students who gave their consent were asked to choose a code name to protect both the security of duplicated data and student privacy, and the Student Information Form, pre-tests the Motivation Strategies for Learning Questionnaire (MSLQ) and the Cognitive Load Scale (CLS) were administered. For three weeks (15 hours), the "Drug Administration" unit was presented to both the experimental and control groups via PowerPoint presentations. This unit was divided into three main topics: "Oral and local drug administration," "Parenteral drug administration," and "Complications of intravenous fluid therapy." These sections also included information on the importance of intramuscular (IM) administration, points to consider during and after administration, administration steps, and potential complications. Following the presentations, students reinforced their knowledge about Drug Administration" unit through question-and-answer sessions and discussions. Following the standard lesson, students in both the experimental and control groups were taken to the vocational skills lab. A video of the IM skill application was projected once, and then an instructor explained the IM application again using a skill mannequin. Students in the experimental group were presented with two puzzles before the first skill application on the mannequin: one focusing on the concepts related to the skill and the other on the steps of skill application, and were asked to solve them. After solving the puzzles, students submitted them to their instructors. In the two weeks following this training, students first solved the same puzzle, researcher collected the crossword puzzles, and then students performed the IM skill application on a skill mannequin. After solving the puzzle and performing the skill application a total of three times, students took post test the CLS and MSLQ and a skills exam four weeks later. During the application process, the control group of students received standard training and then students took post test the Cognitive Load Scale and Motivation Scale and a skills exam four weeks later. After the skills exam, all students were given the puzzle to help consolidate their learning. This skills test did not affect the students' academic averages. For the sample size calculation of the study, since there is insufficient data in the literature on the effect of Motivation Strategies for Learning Questionnaire, cognitive load, and intramuscular skills of nursing students, it was calculated that 64 students from each group (experimental=64, control=64) should be included in the study with a 5% margin of error and 80% power value to test the moderate effect size (d=0.5) prediction of the puzzle intervention. Given the potential losses during the research process, 70 students will be included in each group. Turkish version of Motivated Strategies for Learning Questionnaire and Cognitive Load Scale, and skill exams specific to M skill application were used for data collection.
Students in the experimental group were presented with two puzzles before the first skill application on the mannequin: one focusing on the concepts related to the skill and the other on the steps of skill application, , and were asked to solve them. After solving the puzzles, students submitted them to their instructors. In the two weeks following this training, students first solved the same puzzle, researcher collected the crossword puzzles, and then students performed the IM skill application on a skill mannequin. After solving the puzzle and performing the skill application a total of three times, students took post test the CLS and MSLQ and a skills exam four weeks later.
During the application process, the control group of students received standard training.
Trakya University
Edirne, Edirne, Turkey (Türkiye)
Cognitive Load Scale
The 9-point rating scale developed by Paas and Van Merrienboer (1993) and adapted into Turkish by Kılıç and Karadeniz (2004) was used to calculate students' cognitive load scores. The scale consists of a single item and measures the effort students expend while performing a task, and this effort is taken as an indicator of cognitive load. The lowest score on the scale is 1 and the highest is 9, and the higher the score, the higher the level of cognitive load.
Time frame: Before courses begin and 4 weeks after the courses concluded, an average of 3 months
The Motivated Strategies for Learning Questionnaire (MSLQ)
The questionnaire was developed by Pintrich et al. in 1991.24 It was adapted to Turkish language by by Büyüköztürk et al. in 2004. This scale allowing students to indicate how well the items describe their personal situation. This scale consists of two main section, learning strategies and motivation, and 15 sub-dimensions. Responses are provided on a 7-point Likert scale, ranging from "not at all true of me" to "very true of me". In this study, the motivation section with its 6 sub-dimensions were applied to the students. Each sub-dimension is scored separately, and increasing scores indicate increased student motivation.
Time frame: Before courses begin and 4 weeks after the courses concluded, an average of 3 months
Checklist of Intramuscular Injection Skills
To measure nursing skills, the researchers converted items from the intramuscular injection skills test into a checklist format.The checklist, which consisted of 29 steps to perform intramuscular injection skills in the ventrogluteal region, was created based on the literature, and each step of the checklist was scored. Scores of the checklist were generated based on a100 point scale. The higher score students get from the checklist, higher their intramuscular injection skill performance.
Time frame: 4 weeks after the courses concluded, an average of 3 months
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Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
140