Nursing Students→ PIM-CrossworNCT07544810
Puzzle-Based Learning on Nursing Students' Parenteral Medication Knowledge and Motivation
A study testing Puzzle-Based Learning Activity in people with Nursing Students, run by Gazi University.
Trial summary
This randomized, controlled, parallel-group, interventional study aims to evaluate the effects of Crossword-Based Learning for Parenteral Drug Administration on the knowledge level, self-efficacy perception, and learning motivation of Nursing Department students. Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Nursing Students
- What is being tested?
- Puzzle-Based Learning Activity
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 80 participants
- Where
- No sites listed yet
- Study dates
- 28 Apr 2026to 15 Sep 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 18 years and older
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Being enrolled as a 2nd-year student in the Nursing Department of the Faculty of Health Sciences at Kütahya Health Sciences University.
- Being registered for the "Fundamental Principles and Practices in Nursing" course.
Who cannot join
- Not completing the pre-test or post-test data collection forms.
- Being on medical or academic leave during the study period.
- Having previously received structured training related to parenteral medication administration within the past 6 months.
- Participating in another educational intervention study at the same time.
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
About this study
Official title: The Effect of Crossword-Based Learning on Parenteral Drug Administration on Nursing Students' Knowledge Level, Self-Efficacy Perception, and Learning Motivation
This randomized, controlled, parallel-group, interventional study aims to evaluate the effects of Crossword-Based Learning for Parenteral Drug Administration on the knowledge level, self-efficacy perception, and learning motivation of Nursing Department students. It is considered original because it examines the effects of crossword-based learning on cognitive and psychosocial outcomes in parenteral drug administration, a skill with a high risk of error in the clinical field. The study will be conducted with 80 (40 Experimental, 40 Control) nursing students selected through a power analysis. Participants will be assigned to groups by random assignment, and the study will be conducted in accordance with the triple-blind principle (participant, data collector, statistician). The experimental group will receive Crossword Activities in four different phases (Initial, Theoretical, Laboratory, and Post-Clinical Practice) in addition to the standard educational content. The control group will only complete the standard education. The primary outcomes of the study are; At the end of the 4th stage, the Parenteral Drug Administration Knowledge Test will be evaluated based on the Safe Parenteral Drug Administration Self-Efficacy Scale (SES-SES) and the Higher Education Learning Motivation Scale (SLS-SES) scores.
Read the detailed description
Parenteral medication administration is among the fundamental clinical skills of the undergraduate nursing curriculum and is crucial for safe medication management. According to the 2022 National Core Education Program for Nursing (HUÇEP), parenteral medication administration is defined as a mandatory professional competency that nursing students must acquire before graduation (Competency Code: D3). Accordingly, nursing students must integrate their theoretical knowledge of anatomy and pharmacology with technical knowledge and apply it to practice using appropriate methods and techniques in the clinical field. Medication administration is a nursing practice with a high rate of errors in healthcare and can lead to serious clinical consequences that can directly threaten patient safety. Furthermore, this global context also brings with it significant financial losses. According to a report published as part of the World Health Organization (WHO) initiative, "Global Patient Safety Challenge: Medication Without Harm," medication errors account for an annual economic burden of approximately $42 billion. This report does not include specific numerical data on parenteral medication administration; however, it emphasizes that parenteral medication administration carries a higher risk than other routes of administration. Therefore, to minimize the rate of errors resulting from medication errors in general and parenteral medication administration in particular, it is crucial that students possess a strong theoretical foundation, sound psychomotor skills, and a certain level of self-efficacy in their practice. Nursing students' self-efficacy regarding their knowledge and practices regarding medications and medication administration is one of the indicators that nursing education programs have achieved their goals regarding medication administration. In this regard, with the integration of current teaching approaches into nursing education in recent years, game-based learning strategies that make the learning process more active, fun, participatory, and motivating have begun to come to the fore. Among these strategies, crossword puzzles, in particular, are defined as an effective tool for associating complex concepts, learning terminology, increasing knowledge retention, and ensuring student participation. In a randomized controlled study, it was reported that hook and word search puzzles had a statistically significant difference in nursing students' knowledge levels of parenteral drug administration. In another study conducted with nursing students, it was reported that students who used puzzles understood the subject better, felt more competent, and enjoyed the learning process more. Similarly, in the literature, studies conducted with various health sciences students as well as nursing students show that the use of puzzles as an instructional material increases student motivation and interest in the course, makes learning enjoyable, and strengthens retention. However, a review of the literature reveals that studies conducted with the puzzle-based learning approach largely examine the effects on students' knowledge levels. However, two psychosocial factors that are at least as important as knowledge for success in nursing education and clinical practice are self-efficacy perception and motivation to learn. These two concepts support students' intrinsic motivation, increasing their active participation in the learning process, their sense of curiosity, and their willingness to exert effort. A review of the literature reveals no studies evaluating the impact of crossword-based learning activities on parenteral medication administration on nursing students' knowledge, self-efficacy perceptions, and learning motivation. The originality of this study stems from its assessment of not only cognitive gains but also students' psychosocial learning components. Therefore, this study, which is anticipated to contribute to the theoretical and clinical education processes related to parenteral medication administration in nursing, particularly to the nursing literature, aims to evaluate the impact of crossword-based learning activities on nursing students' knowledge, self-efficacy perceptions, and learning motivation.
- Conditions
- Nursing Students
- Being tested
- Puzzle-Based Learning Activity
- Keywords
- nursing student, Crossword puzzle, drug administration, motivation, self-sufficiency
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Puzzle-Based Learning ActivityBehavioural
A structured puzzle-based (crossword) learning activity developed to reinforce theoretical content on parenteral medication administration. The activity aims to enhance knowledge retention, strengthen concept integration, and promote active engagement among nursing students.
| Study group | Role | What they receive |
|---|---|---|
| Intervention Group | Experimental | Students in the intervention group will receive the structured theoretical lesson content together with a puzzle-based learning activity (çengel bulmaca). The activity is designed to reinforce knowledge, promote active learning, and support concept integration. Receives: Behavioral: Puzzle-Based Learning Activity |
| Control Group | No intervention | Students in the control group will receive only the structured theoretical lesson content without any puzzle-based activity. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Knowledge Level Related to Parenteral Medication Administration
Parenteral medication knowledge will be assessed using the Parenteral Medication Knowledge Test developed by the researchers. The test consists of 20 multiple-choice questions covering medication preparation, aseptic technique, administration principles, and clinical decision-making. Each correct answer is scored as 1 point and incorrect answers as 0 points. Total scores range from 0 to 20, with higher scores indicating greater knowledge. The outcome will be evaluated as the change in total scores between measurement time points.
Measured: Baseline (Week 0) and after intervention (Week 4)
Secondary outcomes (2)
Change in Learning Motivation (YÖMÖ-Ü)
Change in Learning Motivation (YÖMÖ-Ü): Learning motivation will be assessed using the Motivation for Learning in Higher Education Scale (YÖMÖ-Ü). The scale consists of 26 items rated on a 3-point Likert scale (1 = Disagree, 2 = Neutral, 3 = Agree). Total scores range from 26 to 78, with higher scores indicating higher levels of learning motivation. The outcome will be evaluated as the change in total scores across measurement time points.
Measured: Baseline (Week 0), Post-Theoretical Training (Week 2), and Final Assessment (Week 10)
Change in Self-Efficacy Related to Safe Parenteral Medication Administration
Self-efficacy will be assessed using the Safe Parenteral Medication Administration Self-Efficacy Scale (GPİU-ÖYÖ). The scale consists of 76 items rated on a 5-point Likert scale (1 = Strongly disagree to 5 = Strongly agree). Total scores range from 76 to 380, with higher scores indicating greater self-efficacy. The scale evaluates confidence in medication preparation, safe administration practices, error prevention, and clinical decision-making. The outcome will be evaluated as the change in total scores across measurement time points.
Measured: Baseline (Week 0) and after clinical practice (Week 10)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Apr 2026
- Study start28 Apr 2026 (estimated)
- Primary completion15 Jul 2026 (estimated)
- Study completion15 Sep 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Nursing StudentsStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
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
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Single-center, two-arm, parallel-group, triple-blind, randomized controlled, repeated-measures experimental study
- Masking
- Double blind
- Who is masked
- Participant, Investigator
- Enrolment
- 80 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Gazi University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Ferzan Kalaycı Emek, Kutahya Health Sciences University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07544810
- Sponsor's protocol ID
- GY-HM-FKE-01
- Other IDs
- GY-HM-FKE-01
- Acronym
- → PIM-Crosswor
- Status last verified
- Apr 2026
- First submitted
- 21 Nov 2025
- Last updated
- 22 Apr 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Bahar, A., Arslan, M., Gokgoz, N., Ak, H., & Kaya, H. (2017). Do parenteral medication administration skills of nursing students increase with educational video materials? International Journal of Caring Sciences, 10(3), 1514-1525. Turkish Nursing Education Association. (2022). National Core Education Program in Nursing (HUÇEP 2022). https://www.hemed.org.tr/2022-hucep/ Karaahmetoğlu, G. U. (2019). Investigation of nursing students' knowledge levels regarding intramuscular injection practices. Abant Medical Journal, 8(3), 155-161. Foss, K., & Morandini, S. (2023). Using objective structured clinical examination to teach medication rights in undergraduate nursing education. Journal of Professional Nursing, 45, 89-93. https://doi.org/10.1016/j.profnurs.2023.01.007 Kırşan, M., Korhan, E. A., Şimşek, S., Özçiftçi, S., & Ceylan, B. (2019). Medication errors in nursing practices: A systematic review. Turkiye Klinikleri Journal of Nursing Sciences, 11(1). World Health Organization. (2024). Medication without harm: Policy brief. Geneva, Switzerland: WHO. Kelly, S. H., Koharchik, L., Henry, R., Cippel, M., Hardner, S., Kolesar, A., & Clark, B. (2018). An advanced medication administration experience to promote students' knowledge acquisition. Teaching and Learning in Nursing, 13(2), 104-107. Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing students' understanding of medication safety. Nurse Education in Practice, 15(1), 17-21. Zaybak, A., Taşkıran, N., Telli, S., Ergin, E. Y., & Şahin, M. (2017). Nursing students' opinions regarding sufficiency of their drug administration knowledge. Journal of Education and Research in Nursing, 14(1), 6-14. Doğan, S. E., & Aslan, H. (2024). Current teaching methods and techniques used in nursing education. Bingöl University Journal of Health, 5(1), 224-235. Alcindor, M. L. (2022). Application of a crossword puzzle tournament to prepare nursing students for examinations. Nurse Educator, 47(6), E152-E1
Study at a glance
From the registry record, last updated by the sponsor on 22 Apr 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Crossword-Based Learning on Parenteral Drug Administration on Nursing Students' Knowledge Level, Self-Efficacy Perception, and Learning Motivation
- ClinicalTrials.gov ID
- NCT07544810
- Acronym / sponsor ID
- → PIM-Crosswor / GY-HM-FKE-01
- Conditions
- Nursing Students
- Keywords
- nursing student, Crossword puzzle, drug administration, motivation, self-sufficiency
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 80 participants (estimated)
- Lead sponsor
- Gazi UniversityUniversity, hospital or other
- Study start
- 28 Apr 2026 (estimated)
- Primary completion
- 15 Jul 2026 (estimated)
- Study completion
- 15 Sep 2026 (estimated)
- First posted
- 22 Apr 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This randomized, controlled, parallel-group, interventional study aims to evaluate the effects of Crossword-Based Learning for Parenteral Drug Administration on the knowledge level, self-efficacy perception, and learning motivation of Nursing Department students. It is considered original because it examines the effects of crossword-based learning on cognitive and psychosocial outcomes in parenteral drug administration, a skill with a high risk of error in the clinical field. The study will be conducted with 80 (40 Experimental, 40 Control) nursing students selected through a power analysis. Participants will be assigned to groups by random assignment, and the study will be conducted in accordance with the triple-blind principle (participant, data collector, statistician). The experimental group will receive Crossword Activities in four different phases (Initial, Theoretical, Laboratory, and Post-Clinical Practice) in addition to the standard educational content. The control group will only complete the standard education. The primary outcomes of the study are; At the end of the 4th stage, the Parenteral Drug Administration Knowledge Test will be evaluated based on the Safe Parenteral Drug Administration Self-Efficacy Scale (SES-SES) and the Higher Education Learning Motivation Scale (SLS-SES) scores.
Detailed description
Parenteral medication administration is among the fundamental clinical skills of the undergraduate nursing curriculum and is crucial for safe medication management. According to the 2022 National Core Education Program for Nursing (HUÇEP), parenteral medication administration is defined as a mandatory professional competency that nursing students must acquire before graduation (Competency Code: D3). Accordingly, nursing students must integrate their theoretical knowledge of anatomy and pharmacology with technical knowledge and apply it to practice using appropriate methods and techniques in the clinical field. Medication administration is a nursing practice with a high rate of errors in healthcare and can lead to serious clinical consequences that can directly threaten patient safety. Furthermore, this global context also brings with it significant financial losses. According to a report published as part of the World Health Organization (WHO) initiative, "Global Patient Safety Challenge: Medication Without Harm," medication errors account for an annual economic burden of approximately $42 billion. This report does not include specific numerical data on parenteral medication administration; however, it emphasizes that parenteral medication administration carries a higher risk than other routes of administration. Therefore, to minimize the rate of errors resulting from medication errors in general and parenteral medication administration in particular, it is crucial that students possess a strong theoretical foundation, sound psychomotor skills, and a certain level of self-efficacy in their practice. Nursing students' self-efficacy regarding their knowledge and practices regarding medications and medication administration is one of the indicators that nursing education programs have achieved their goals regarding medication administration. In this regard, with the integration of current teaching approaches into nursing education in recent years, game-based learning strategies that make the learning process more active, fun, participatory, and motivating have begun to come to the fore. Among these strategies, crossword puzzles, in particular, are defined as an effective tool for associating complex concepts, learning terminology, increasing knowledge retention, and ensuring student participation. In a randomized controlled study, it was reported that hook and word search puzzles had a statistically significant difference in nursing students' knowledge levels of parenteral drug administration. In another study conducted with nursing students, it was reported that students who used puzzles understood the subject better, felt more competent, and enjoyed the learning process more. Similarly, in the literature, studies conducted with various health sciences students as well as nursing students show that the use of puzzles as an instructional material increases student motivation and interest in the course, makes learning enjoyable, and strengthens retention. However, a review of the literature reveals that studies conducted with the puzzle-based learning approach largely examine the effects on students' knowledge levels. However, two psychosocial factors that are at least as important as knowledge for success in nursing education and clinical practice are self-efficacy perception and motivation to learn. These two concepts support students' intrinsic motivation, increasing their active participation in the learning process, their sense of curiosity, and their willingness to exert effort. A review of the literature reveals no studies evaluating the impact of crossword-based learning activities on parenteral medication administration on nursing students' knowledge, self-efficacy perceptions, and learning motivation. The originality of this study stems from its assessment of not only cognitive gains but also students' psychosocial learning components. Therefore, this study, which is anticipated to contribute to the theoretical and clinical education processes related to parenteral medication administration in nursing, particularly to the nursing literature, aims to evaluate the impact of crossword-based learning activities on nursing students' knowledge, self-efficacy perceptions, and learning motivation.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Double blind (participant, investigator)
- Number of arms
- 2
- Model description
- Single-center, two-arm, parallel-group, triple-blind, randomized controlled, repeated-measures experimental study
| Arm | Type | Receives |
|---|---|---|
| Intervention Group | Experimental | Behavioral: Puzzle-Based Learning ActivityStudents in the intervention group will receive the structured theoretical lesson content together with a puzzle-based learning activity (çengel bulmaca). The activity is designed to reinforce knowledge, promote active learning, and support concept integration. |
| Control Group | No intervention | –Students in the control group will receive only the structured theoretical lesson content without any puzzle-based activity. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Being enrolled as a 2nd-year student in the Nursing Department of the Faculty of Health Sciences at Kütahya Health Sciences University.
- Being registered for the "Fundamental Principles and Practices in Nursing" course.
Key exclusion criteria (4 listed)
- Not completing the pre-test or post-test data collection forms.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Puzzle-Based Learning ActivityA structured puzzle-based (crossword) learning activity developed to reinforce theoretical content on parenteral medication administration. The activity aims to enhance knowledge retention, strengthen concept integration, and promote active engagement among nursing students. | Behavioural | Intervention Group |
Primary outcome
Change in Knowledge Level Related to Parenteral Medication Administration
Time frame: Baseline (Week 0) and after intervention (Week 4)
Parenteral medication knowledge will be assessed using the Parenteral Medication Knowledge Test developed by the researchers. The test consists of 20 multiple-choice questions covering medication preparation, aseptic technique, administration principles, and clinical decision-making. Each correct answer is scored as 1 point and incorrect answers as 0 points. Total scores range from 0 to 20, with higher scores indicating greater knowledge. The outcome will be evaluated as the change in total scores between measurement time points.
2 secondary outcomes
Change in Learning Motivation (YÖMÖ-Ü)
Time frame: Baseline (Week 0), Post-Theoretical Training (Week 2), and Final Assessment (Week 10)
Change in Self-Efficacy Related to Safe Parenteral Medication Administration
Time frame: Baseline (Week 0) and after clinical practice (Week 10)
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Apr 2026.
- BackgroundBahar, A., Arslan, M., Gokgoz, N., Ak, H., & Kaya, H. (2017). Do parenteral medication administration skills of nursing students increase with educational video materials? International Journal of Caring Sciences, 10(3), 1514-1525. Turkish Nursing Education Association. (2022). National Core Education Program in Nursing (HUÇEP 2022). https://www.hemed.org.tr/2022-hucep/ Karaahmetoğlu, G. U. (2019). Investigation of nursing students' knowledge levels regarding intramuscular injection practices. Abant Medical Journal, 8(3), 155-161. Foss, K., & Morandini, S. (2023). Using objective structured clinical examination to teach medication rights in undergraduate nursing education. Journal of Professional Nursing, 45, 89-93. https://doi.org/10.1016/j.profnurs.2023.01.007 Kırşan, M., Korhan, E. A., Şimşek, S., Özçiftçi, S., & Ceylan, B. (2019). Medication errors in nursing practices: A systematic review. Turkiye Klinikleri Journal of Nursing Sciences, 11(1). World Health Organization. (2024). Medication without harm: Policy brief. Geneva, Switzerland: WHO. Kelly, S. H., Koharchik, L., Henry, R., Cippel, M., Hardner, S., Kolesar, A., & Clark, B. (2018). An advanced medication administration experience to promote students' knowledge acquisition. Teaching and Learning in Nursing, 13(2), 104-107. Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing students' understanding of medication safety. Nurse Education in Practice, 15(1), 17-21. Zaybak, A., Taşkıran, N., Telli, S., Ergin, E. Y., & Şahin, M. (2017). Nursing students' opinions regarding sufficiency of their drug administration knowledge. Journal of Education and Research in Nursing, 14(1), 6-14. Doğan, S. E., & Aslan, H. (2024). Current teaching methods and techniques used in nursing education. Bingöl University Journal of Health, 5(1), 224-235. Alcindor, M. L. (2022). Application of a crossword puzzle tournament to prepare nursing students for examinations. Nurse Educator, 47(6), E152-E1
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Questions about this trial
What is this clinical trial studying?
A study testing Puzzle-Based Learning Activity in people with Nursing Students, run by Gazi University.
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 2 inclusion and 4 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: opening soon, as of the sponsor's last update on 22 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.
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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact FERZAN KALAYCI EMEK, RESEARCH Asistan (+905436540498, ferzan.kalayciemek@ksbu.edu.tr), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Knowledge Level Related to Parenteral Medication Administration (time frame: Baseline (Week 0) and after intervention (Week 4)). 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 NCT07544810, which also lists 1 linked publication.
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 22 Apr 2026.