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

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.