The Effectiveness of the Puzzle Method on Nursing Students' Infection Control Learning Level

NCT07584694 | Completed

• 1 other identifier: OMU-SBF-HEM-ESAS-25
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to evaluate the effect of the puzzle teaching technique on the infection control knowledge levels of first-year nursing students. Infection control and asepsis represent fundamental competencies that are essential for patient safety and quality of care. Despite the recognized importance of these concepts, many undergraduate nursing students struggle to retain theoretical information and apply it effectively in clinical practice when exposed only to traditional, lecture-based instruction. Active learning approaches have been shown to enhance students' engagement, motivation, and long-term knowledge retention compared to conventional teaching methods. Among these approaches, puzzle-based learning has recently emerged as an innovative, low-cost, and enjoyable educational tool that promotes active participation, problem-solving, and conceptual understanding. By integrating play and cognitive challenge, puzzles help learners reinforce complex theoretical content and recall it more effectively. In this study, first-year nursing students enrolled in a fundamentals of nursing course will be randomly assigned to either an experimental group or a control group. Both groups will first receive standard theoretical instruction on infection control and asepsis delivered through traditional lectures. Following this, the experimental group will participate in a three-week puzzle-based learning intervention, while the control group will receive no additional activities beyond the standard lecture. The puzzle intervention will include weekly, instructor-led sessions where students collaboratively complete custom-designed educational puzzles-such as crosswords, matching games, and problem-solving tasks-focused on infection control concepts (hand hygiene, aseptic technique, sterilization, personal protective equipment, and prevention of healthcare-associated infections). Each session will last approximately 45-60 minutes and will emphasize group interaction, peer discussion, and immediate feedback. Data will be collected using a pre-test/post-test design. All participants will complete a structured infection control knowledge test before the intervention, immediately after the three-week period, and again four weeks later to assess retention. In addition, a short questionnaire will be administered to the experimental group to measure student satisfaction and perceived learning effectiveness associated with the puzzle technique. The primary outcome is the change in infection control knowledge scores from pre-test to post-test. Secondary outcomes include knowledge retention at four weeks and students' satisfaction with the learning experience. Statistical analyses will compare mean score differences between and within groups using appropriate parametric or non-parametric tests. This study is grounded in Kolb's experiential learning theory and Bloom's revised taxonomy, both of which support active, student-centered approaches that promote deep learning. Puzzle-based learning is expected to enhance cognitive engagement, encourage self-directed learning, and strengthen understanding of core infection control principles. By evaluating the effectiveness of this interactive teaching strategy, the study aims to provide empirical evidence supporting the integration of active learning methods into nursing curricula. The findings will contribute to the development of more engaging, effective, and evidence-based instructional strategies in nursing education, particularly for first-year students learning infection control and aseptic techniques. It is anticipated that the puzzle teaching technique will improve students' theoretical knowledge, increase their motivation for learning, and support safer future clinical practice.

Conditions

Nursing Students; Puzzle Activity; Infection Control Training

Outcome Measures

Primary Outcomes (1)

• Change in Infection Control Knowledge Scores

  Knowledge levels related to infection control and asepsis will be measured using the Infection Control Knowledge Test, a 50-item multiple-choice instrument developed and validated by the researchers. The test evaluates students' understanding of infection prevention concepts, aseptic technique, isolation precautions, sterilization, and waste management. Scores range from 0 to 50, with higher scores indicating greater knowledge. The primary outcome will be the mean change in total knowledge scores between pre-test and post-test measurements, comparing the experimental (puzzle) and control (lecture-only) groups. Statistical Analysis: Between-group comparisons will be conducted using independent-samples t-tests (or Mann-Whitney U tests if data are non-normal). Within-group changes will be evaluated using paired-samples t-tests (or Wilcoxon signed-rank tests). Statistical significance will be set at p \< 0.05.

  Pre-test (Week 0, before intervention) Post-test 1 (Four weeks after intervention for retention assessment)

Secondary Outcomes (2)

• Effect Size and Educational Impact

  Post-test (Week 4)

• Knowledge Retention at 4 Weeks

  Four weeks after the completion of the 3-week intervention

Study Arms (2)

Experimantal: Intervention group

EXPERIMENTAL

Arm 1 - Experimental: Puzzle Teaching Technique Participants assigned to the experimental group will receive standard theoretical and laboratory instruction on infection control and asepsis, followed by an additional three-week intervention using the puzzle teaching technique. After the conventional lectures, students will attend weekly, instructor-guided puzzle sessions designed to reinforce infection control concepts such as hand hygiene, isolation precautions, aseptic technique, sterilization, waste management, and the chain of infection. Each session will last approximately 45-60 minutes and include: Collaborative puzzle-solving activities (crosswords, matching, fill-in-the-blanks), Immediate feedback and discussion facilitated by the researchers, Projection of completed puzzles for class review and clarification of misconceptions. Students will complete a pre-test, a post-test immediately after the intervention, and a follow-up test four weeks later to assess knowledge retention.

Behavioral: Puzzle Teaching Technique

Experimantal: Control group

NO INTERVENTION

Arm 2 - Control: Traditional Lecture-Based Education Participants in the control group will receive the same standard theoretical and laboratory instruction on infection control and asepsis as the experimental group but will not participate in any puzzle-based activities.The control group will follow the traditional, instructor-centered teaching method that includes didactic lectures and laboratory demonstrations. Students will complete the same pre-test, post-test, and follow-up knowledge assessments as the experimental group but will not receive any additional intervention. After completion of the data collection phase, the educational puzzles used in the experimental group will be shared with the control group as supplementary learning material to ensure equity in educational exposure.

Interventions

Puzzle Teaching Technique BEHAVIORAL

The puzzles will be developed using https://crosswordlabs.com and aligned with course learning objectives. Students will complete a pre-test, a post-test immediately after the intervention, and a follow-up test four weeks later to assess knowledge retention. Intervention Name: Puzzle Teaching Technique Intervention Type: Behavioral (Active Learning Strategy) Duration: 3 consecutive weeks following theoretical instruction Frequency: 1 session per week (45-60 minutes per session)

Experimantal: Intervention group

Eligibility Criteria

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

You may qualify if:

• Volunteering to participate in the study,
• Taking the Fundamentals of Nursing course for the first time

You may not qualify if:

• Not volunteering to participate in the study.
• Graduating from a health vocational high school or an associate's degree.
• Not continuing the study.

Sponsors & Collaborators

• Ondokuz Mayıs University: lead

Study Sites (1)

Ondokuz Mayıs Üniversitesi

Samsun, Samsun, 55200, Turkey (Türkiye)

Location

Related Publications (3)

• 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.

  PMID: 37023523 RESULT

• 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.

  PMID: 37544239 RESULT

• 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.

  PMID: 36116385 RESULT

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Tuğba Kavalalı Erdoğan, Phd. Candidate, Principle Invest,gator, Ondokuz Mayıs University

Model Details: The study was in the experimental type and was conducted as a longitudinal randomized controlled study according to the pretest-posttest trial model.

Study Record Dates

• First Submitted: May 1, 2026
• First Posted: May 13, 2026
• Study Start: October 30, 2025
• Primary Completion: November 1, 2025
• Study Completion: January 30, 2026
• Last Updated: May 13, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)