This randomized controlled trial (RCT) with a pretest-posttest design aimed to determine the effect of a game-based escape room teaching method on intern nursing students' knowledge levels regarding pressure ulcers. The study was conducted at the Faculty of Nursing, Aydın Adnan Menderes University between March and December 2025. A total of 56 senior nursing students were randomly assigned to either the intervention group (n = 28) or the control group (n = 28). The intervention group received both theoretical instruction and escape room-based learning activities, while the control group received only traditional lecture-based theoretical instruction. Data were collected using the Student Information Form, the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T), and the Gameful Experience Scale (GAMEX). The primary outcome was the change in pressure ulcer knowledge levels measured using the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T) across three time points: baseline, immediately after theoretical instruction, and 1 month after the intervention.
This study was designed as a randomized controlled trial (RCT) with repeated measures (pretest-posttest design). After completion of theoretical instruction on pressure ulcers, participants in the intervention group engaged in structured escape room activities, including crossword puzzles, word search tasks, matching exercises, and puzzle-based problem-solving activities. The control group received only traditional lecture-based instruction. Data were collected at three time points: baseline, immediately after theoretical instruction, and one month after the intervention. Statistical analyses included descriptive statistics, chi-square tests, independent samples t-tests, and two-way repeated measures analysis of variance (ANOVA).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
51
A structured, game-based educational intervention designed to enhance engagement and reinforce knowledge of pressure ulcers. The intervention consisted of multiple interactive learning activities, including crossword puzzles, word search tasks, matching exercises, and puzzle completion activities. These activities were facilitated in a simulated clinical learning environment under instructor supervision. The session was followed by a structured debriefing phase.
Participants in this group received standard lecture-based theoretical instruction on pressure ulcers delivered in a classroom setting. The instruction included face-to-face teaching using presentation, explanation, discussion, and question-answer techniques. No additional educational intervention or game-based learning activities were applied.
Aydın Adnan Menderes University
Aydin, Turkey (Türkiye)
Change in Pressure Ulcer Knowledge Level
Assessed using the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T). The tool is a 25-item questionnaire with scores ranging from 0 to 25. Higher scores indicate a higher level of knowledge regarding pressure ulcer prevention and management.
Time frame: Day 0 (Baseline, October 24, 2025), Day 0 (Immediately post theoretical instruction, October 24, 2025), and Day 33 (1-month follow-up, November 26, 2025)
Gameful Experience Level [assessed using the Gameful Experience Scale (GAMEX)]
The outcome was assessed using the Gameful Experience Scale (GAMEX) developed by Eppmann, Bekk, and Klein (2018). The original scale consists of 27 items covering six dimensions: enjoyment (6 items), absorption (6 items), creative thinking (4 items), activation (4 items), absence of negative affect (3 items), and dominance (4 items). The total score increases with a more positive gameful experience. The Turkish adaptation of the scale was performed by Hatipoğlu and Türker (2018), who conducted validity and reliability analyses. The adapted version consists of 42 items; however, items after item 38 are specific to the marketing field and were excluded in non-marketing studies, including the present study. The Turkish version demonstrated high internal consistency with a Cronbach's alpha coefficient of 0.931. Higher scores indicate a more positive gameful experience during the gamified learning intervention.
Time frame: Day 33 (1-month follow-up, November 26, 2025, post-intervention assessment)
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