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Learning Concepts and SkillsNCT07492017

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

A study testing Crossword Puzzles in people with Learning Concepts and Skills, run by Trakya University at 1 site in Turkey (Türkiye).

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

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. Read more about this study

Who is it for?
Any ageHealthy volunteers can take part
Conditions the study is for
Learning Concepts and Skills
What is being tested?
Crossword Puzzles
Could I receive a placebo?
No, everyone receives an active treatment
How many people
140 participants
Where
1 siteTurkey (Türkiye)
Study dates
9 Feb 2025to 9 Feb 2026
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • Be over 18 years of age,
  • To volunteer,
  • Taking the Fundamentals of Nursing course for the first time,
  • Absence of any psychiatric disorder that will reduce the ability to comprehend and understand,

Who cannot join

  • Being under 18 years of age,
  • Not being a volunteer,
  • Having previously taken the Fundamentals of Nursing course,

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site
  • Trakya University

    Edirne, Edirne, 22030

Other trials in Turkey (Türkiye)

About this study

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.

Read the detailed description

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.

Being tested
Crossword Puzzles, Control group
Keywords
Puzzles, Nursing Students, Intramuscular Injection, Motivation, Skill, Cognitive Load

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Crossword PuzzlesOther

    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.

  • Control groupOther

    During the application process, the control group of students received standard training.

Study groups in NCT07492017
Study groupRoleWhat they receive
The crossword puzzle groupExperimentalThe "Drug Administration" unit was presented via PowerPoint presentations. Following the standard lesson, students in both the experimental group 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.
Receives: Other: Crossword Puzzles
The control groupOtherDuring the application process, the control group of students received standard training (explanation with ppt presentation) .
Receives: Other: Control group

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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.

    Measured: Before courses begin and 4 weeks after the courses concluded, an average of 3 months

  2. 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.

    Measured: Before courses begin and 4 weeks after the courses concluded, an average of 3 months

  3. 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.

    Measured: 4 weeks after the courses concluded, an average of 3 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted25 Mar 2026
  2. Study start9 Feb 2025
  3. Primary completion2 Jun 2025
  4. Study completion9 Feb 2026

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
140 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07492017
Sponsor's protocol ID
TÜTF-BAEK 2024/232
Other IDs
2024/181
Status last verified
Mar 2026
First submitted
19 Mar 2026
Last updated
8 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Hdaib MT, Al-Momany SM, Najjar YW. Knowledge level assessment and change among nursing students regarding administering intra-muscular injection at Al-Balqa'a Applied University: an interventional study. Nurse Educ Today. 2015 Jul;35(7):e18-22. doi: 10.1016/j.nedt.2015.02.012. Epub 2015 Feb 26.

    PubMed 25743095
  • Karaman, D. (2015). Using ventrogluteal site in intramuscular injections is a priority or an alternative. International Journal of Caring Sciences, 8(2), 507.

  • Kılıç, A. G. E., & Karadeniz, Ö. G. Ş. (2004). Hiper ortamlarda öğrencilerin bilişsel yüklenme ve kaybolma düzeylerinin belirlenmesi. Kuram ve Uygulamada Eğitim Yönetimi, 40(40), 562-579.

  • Büyüköztürk, Ş., Akgün, Ö. E., Kahveci, Ö., & Demirel, F. (2004). Güdülenme ve öğrenme stratejileri ölçeğinin Türkçe formunun geçerlik ve güvenirlik çalışması. Kuram ve Uygulamada Eğitim Bilimleri, 4(2), 207-239.

  • Kalkan, N., Demir, S., Ezer, Z. G., & Dalgıç, C. (2025). The effect of using puzzles as a teaching method on the study process and motivation of students taking the operating room nursing course. Global Nursing Insights, 12(2), 197-204.

  • Baris Eren N, Ciftci B. The Use of Puzzles as a Teaching Technique in Nursing Education: A Randomized Controlled Study. J Eval Clin Pract. 2025 Jun;31(4):e70118. doi: 10.1111/jep.70118.

    PubMed 40405577
  • Kalkan N, Guler S, Bulut H, Ay A. Views of students on the use of crossword and word search puzzle as a teaching technique in nursing education: A mixed-method study. Nurse Educ Today. 2022 Dec;119:105542. doi: 10.1016/j.nedt.2022.105542. Epub 2022 Sep 9.

    PubMed 36116385
  • Acun A. The Effect of Puzzles on Nursing Students' Learning Concepts Related to Vital Signs: A Randomized Controlled Study. J Nurs Educ. 2025 Aug;64(8):e98-e102. doi: 10.3928/01484834-20240723-03. Epub 2024 Dec 10.

    PubMed 39653065
  • Kaynak S, Ergun S, Karadas A. The effect of crossword puzzle activity used in distance education on nursing students' problem-solving and clinical decision-making skills: A comparative study. Nurse Educ Pract. 2023 May;69:103618. doi: 10.1016/j.nepr.2023.103618. Epub 2023 Mar 24.

    PubMed 37023523
  • Kose Tosunoz I, Deniz Dogan S. The effect of crossword puzzles on nursing students' learning of concepts related to pain management course: A randomized controlled trial. Nurse Educ Pract. 2023 Aug;71:103740. doi: 10.1016/j.nepr.2023.103740. Epub 2023 Aug 3.

    PubMed 37544239

Questions about this trial

What is this clinical trial studying?

A study testing Crossword Puzzles in people with Learning Concepts and Skills, run by Trakya University at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cognitive Load Scale (time frame: Before courses begin and 4 weeks after the courses concluded, an average of 3 months). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07492017, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2026.

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