Effect of Repeated Crossword Puzzles Experience on The Motivation, Cognitive Load and Intramuscular Injection Skill Learning of Nursing Students

Overview

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.