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

NCT07492017 | Completed

• 2 other identifiers: TÜTF-BAEK 2024/2322024/181
• Study Type: interventional
• Target: 140
• Locations: 1 country
• Sites: 1

Brief 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. 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.

Conditions

Learning Concepts and Skills

Keywords

Puzzles; Nursing Students; Intramuscular Injection; Motivation; Skill; Cognitive Load

Outcome Measures

Primary Outcomes (3)

• 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.

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

• 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.

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

• 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.

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

Study Arms (2)

The crossword puzzle group

EXPERIMENTAL

The "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.

Other: Crossword Puzzles

The control group

OTHER

During the application process, the control group of students received standard training (explanation with ppt presentation) .

Other: Control group

Interventions

Crossword Puzzles OTHER

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.

The crossword puzzle group

Control group OTHER

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

The control group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• 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,

You may not qualify if:

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

Sponsors & Collaborators

• Trakya University: lead

Study Sites (1)

Trakya University

Edirne, Edirne, 22030, Turkey (Türkiye)

Location

Related Publications (10)

• Hdaib, M. T., Al-Momany, S. M., & Najjar, Y. W. (2015). Knowledge level assessment and change among nursing students regarding administering intra-muscular injection at Al-Balqa'a Applied University: an interventional study. Nurse education today, 35(7), e18-e22.

  BACKGROUND

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

  BACKGROUND

• 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.

  BACKGROUND

• 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.

  BACKGROUND

• 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.

  BACKGROUND

• Barış Eren, N., & Çiftçi, B. (2025). The Use of Puzzles as a Teaching Technique in Nursing Education: A Randomized Controlled Study. Journal of Evaluation in Clinical Practice, 31(4), e70118.

  BACKGROUND

• Kalkan, N., Güler, S., Bulut, H., & Ay, A. (2022). Views of students on the use of crossword and word search puzzle as a teaching technique in nursing education: A mixed-method study. Nurse education today, 119, 105542.

  BACKGROUND

• Acun, A. (2025). The effect of puzzles on nursing students' learning concepts related to vital signs: A randomized controlled study. Journal of Nursing Education, 64(8), e98-e102.

  BACKGROUND

• Kaynak, S., Ergün, S., & Karadaş, A. (2023). The effect of crossword puzzle activity used in distance education on nursing students' problem-solving and clinical decision-making skills: A comparative study. Nurse Education in Practice, 69, 103618.

  BACKGROUND

• Tosunöz, İ. K., & Doğan, S. D. (2023). The effect of crossword puzzles on nursing students' learning of concepts related to pain management course: A randomized controlled trial. Nurse education in practice, 71, 103740.

  BACKGROUND

MeSH Terms

Interventions

Control Groups

Intervention Hierarchy (Ancestors)

Epidemiologic Research Design; Epidemiologic Methods; Investigative Techniques; Research Design; Methods

Study Officials

• Berna AKSOY KAHRAMAN, PhD

  Trakya University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: March 19, 2026
• First Posted: March 25, 2026
• Study Start: February 9, 2025
• Primary Completion: June 2, 2025
• Study Completion: February 9, 2026
• Last Updated: May 8, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)