The effect of diabetes complications education given with puzzles on the knowledge level of nursing students: a quasi-experimental study

Abstract

Aim: The aim of this study was to investigate the effect of puzzles on nursing students' success in learning concepts related to diabetes complications and retention of knowledge.Method: This quasi-experimental, control group study was conducted with second-year nursing students between December 2023 and June 2024. The students were divided into two groups: a puzzle group and a standard education group. The data of the study were collected using the 'Personal Information Form' and the 'Diabetes Complications Knowledge Test' through three measurements: pre-test, post-test, and a retention test conducted four weeks later. Descriptive statistics, Pearson Chi-Square, Fisher Exact Test, Correlation, Independent Sample t Test, and ANOVA test were employed for data analysis. Results: When the knowledge test scores related to diabetes complications were examined, a statistically significant difference was found between the groups based on the retention test results (p<0.05); the puzzle group had higher knowledge test scores. In the study, the outcomes were evaluated by analyzing the effect size between the three measurement points. A significant difference was found between the measurements in the puzzle group, and this difference had a moderate effect size (p<0.05; d=0.45). It was also determined that there was a low level difference in the standard education group (p<0.05; d=0.10). Conclusion: It was concluded that puzzles are an effective method for teaching concepts related to diabetes complications, and that they increase the level of knowledge and retention. As an easy-to-implement, cost-effective, and attractive method, puzzles can be recommended for use in many areas of nursing education.

Keywords

• Diabetes complications
• nursing
• puzzle
• student

Bulmacalar Eşliğinde Verilen Diyabet Komplikasyonları Eğitiminin Hemşirelik Öğrencilerinin Bilgi Düzeyine Etkisi: Yarı Deneysel Bir Çalışma

Abstract

Amaç: Bu çalışmanın amacı, hemşirelik öğrencilerinin diyabet komplikasyonları konusuna ilişkin kavramları öğrenme başarısı ve bilgi kalıcılığı üzerinde bulmacaların etkisini araştırmaktır. Yöntem: Araştırma, yarı deneysel kontrol gruplu bir araştırma olup, Aralık 2023-Haziran 2024 tarihleri arasında, ikinci sınıf hemşirelik bölümü öğrencileriyle yapılmıştır. Araştırmada öğrenciler bulmaca grubu ve standart eğitim grubu olmak üzere iki gruba ayrılmıştır. Araştırmanın verileri “Kişisel Bilgi Formu” ve “Diyabet Komplikasyonlarına İlişkin Bilgi Testi” kullanılarak ön test, son test ve 4 hafta sonra uygulanan kalıcılık testi olmak üzere üç ölçüm yapılarak toplanmıştır. Araştırmanın istatistiksel analizleri IBM SPSS programı kullanılarak verilerin normal dağılım sonuçlarına göre Pearson Ki-Kare, Fisher Exact Testi, Korelasyon, Bağımsız Örneklem t Testi ve ANOVA testi ile yapılmıştır. Bulgular: Diyabet komplikasyonlarına ilişkin bilgi testi puanları incelendiğinde, kalıcılık testi sonuçlarına göre gruplar arasında istatistiksel olarak anlamlı bir fark olduğu belirlenmiştir (p<0.05); bulmaca grubunun bilgi testi puanları daha yüksek bulunmuştur. Çalışmada üç ölçüm arasındaki etki büyüklüğü incelenerek değerlendirilmiştir. Bulmaca grubunda ölçümler arasında anlamlı fark bulunmuş ve bu farkın orta düzeyde etkiye sahip olduğu saptanmıştır (p<0.05; d=0.45). Standart eğitim grubunun ölçümleri arasındaki değişimi incelendiğinde ise üç ölçüm arasında istatistiksel olarak anlamlı bir farklılık bulunduğu ancak bu farklılığın düşük etkiye sahip olduğu saptanmıştır (p<0.05; d=0.10). Sonuç: Sonuç olarak diyabet komplikasyonlarına ilişkin kavramların öğretilmesinde bulmacaların etkili bir yöntem olduğu, bilgi düzeyini ve kalıcılığını artırdığı sonucuna ulaşılmıştır. Uygulaması kolay, maliyet etkin ve ilgi çekici bir yöntem olarak bulmacaların hemşirelik eğitiminde pek çok alanda kullanılması önerilebilir.

Keywords

• Bulmaca
• diyabet komplikasyonları
• hemşirelik
• öğrenci

References

1. Patel SE, Reinkemeyer EA, Chrisman M, Zimmerman C. unlocking learning in radiology nursing: enhancing orientation and emergency response using escape room strategies. Journal of Radiology Nursing. 2015; 1-3 (Article in press) doi: 10.1016/j.jradnu.2024.10.006
2. Kowitlawakul Y, Tan JJM, Suebnukarn S, Nguyen HD, Poo DCC, Chai J, et al. Utilizing educational technology in enhancing undergraduate nursing students' engagement and motivation: a scoping review. J Prof Nurs. 2022;42(september-october): 262–275. doi: 10.1016/j.profnurs.2022.07.015
3. Köse Tosunöz İ, Deniz Doğan 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;1(103740):1-7. doi: 10.1016/j.nepr.2023.103740.
4. Shawahna R, Jaber M. Crossword puzzles improve learning of Palestinian nursing students about pharmacology of epilepsy: Results of a randomized controlled study. Epilepsy Behav. 2020; 106;(107024): 1-10 doi: 10.1016/j.yebeh.2020.107024.
5. Alavi A, Okhovat F. Effects of training nursing process using the concept map on caring self-efficacy of nursing students in pediatric departments. J Educ Health Promot. 2024; 29(13):1-6. doi: 10.4103/jehp.jehp_997_23
6. Yarmohammadi A, Mostafazadeh F, Shahbazzadegan S. Comparison lecture and concept map methods on the level of learning and satisfaction in puerperal sepsis education of midwifery students: a quasi-experimental study. BMC Med Educ. 2023;23(251): 1-7. doi: 10.1186/s12909-023-04247-8
7. Liu W. Development of clinical decision-making among undergraduate nursing students: the effect of unfolding case-based learning. International journal of nursing education scholarship. International Journal of Nursing Education Scholarship. 21(1):1-12. doi: 10.1515/ijnes-2023-0115
8. Quek LH, Tan AJQ, Sim MJJ, Ignacio J, Harder N, Lamb A, et al. Educational escape rooms for healthcare students: A systematic review. Nurse Educ Today. 2024;132(106004):1-9. doi: 10.1016/j.nedt.2023.106004.

9. Hökkä M, Rajala M, Kaakinen P, Lehto JT, Pesonen HM. The effect of teaching methods in palliative care education for undergraduate nursing and medical students: a systematic review. Int J Palliat Nurs. .28(6), 245–253. doi: 10.12968/ijpn.2022.28.6.245.
10. Pivač S, Skela-Savič B, Jović D, Avdić M, Kalender-Smajlović S. Implementation of active learning methods by nurse educators in undergraduate nursing students' programs- a group interview. BMC nursing. 2021;20(173):1-10. doi: 10.1186/s12912-021-00688-y
11. Bilik Ö, Kankaya EA, Deveci Z. Effects of web-based concept mapping education on students' concept mapping and critical thinking skills: A double blind, randomized, controlled study. Nurse Educ Today. 2020;86(104312):1-6. doi: 10.1016/j.nedt.2019.104312.
12. Rushdan EE, Mohamed MAES, Abdelhalim GE, El-Ashry AM, Ali HFM. Effect of an escape room as a gamification evaluation tool on clinical reasoning and teamwork skills among nursing students: A quasi-experimental study. Nurse Educ Pract. 2025;82(104188):1-9. doi: 10.1016/j.nepr.2024.104188.
13. Joseph MA, Natarajan J, Labrague L, Al Omari O. Paradoxical effect of flipped classroom on nursing students' learning ability and satisfaction in a fundamental of nursing clinical course: A quasi-experimental study. J Prof Nurs. 2025; 57(2025):112–120. doi: 10.1016/j.profnurs.2025.01.011.
14. Xue M, Sun H, Xue J, Zhou J, Qu J, Ji S, et al. Narrative medicine as a teaching strategy for nursing students to developing professionalism, empathy and humanistic caring ability: a randomized controlled trial. BMC Med Educ. 2023;23(38):1-11. doi: 10.1186/s12909-023-04026-5.
15. International Diabetes Federation (IDF) [Internet]. Diabetes Atlas 10th Edition. 2021 [Erişim Tarihi: 19.10.2023]. Erişim linki: IDF_Atlas_10th_Edition_2021.pdf
16. Bawazeer G, Sales I, Albogami H, Aldemerdash A, Mahmoud M, Aljohani MA, et al. Crossword puzzle as a learning tool to enhance learning about anticoagulant therapeutics. BMC Med Educ. 2022;22(1):267. doi: 10.1186/s12909-022-03348-0
17. Zamani P, Biparva Haghighi S, Ravanbakhsh M. The use of crossword puzzles as an educational tool. Journal of advances in medical education & professionalism.2021;9(2):102–108. doi:10.30476/jamp.2021.87911.1330
18. Bai P, Zang X, Liu R, Wang L, Dai C, Yang G. In-situ simulation for nursing students' professional competence development in postanesthesia care: A quasi-experimental study. Nurse Educ Pract. 2023;70(103660):1-8. doi: 10.1016/j.nepr.2023.103660.
19. Kalkan N, Güler 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;119(105542): 1-8. doi: 10.1016/j.nedt.2022.105542.
20. Özdemir A, Ünal E. The effect of breast self-examination training on nursing students by using hybrid-based simulation on knowledge, skills, and ability to correctly evaluate pathological findings: Randomized Controlled Study. Nurse Educ Pract. 2023;66(103530):1-8 doi: 10.1016/j.nepr.2022.103530
21. Rodríguez-Abad C, Martínez-Santos AE, Fernández-de-la-Iglesia JD, Rodríguez-González R. Online (versus face-to-face) augmented reality experience on nursing students' leg ulcer competency: Two quasi-experimental studies. Nurse Educ Pract. 2023;71(103715):1-9. doi: 10.1016/j.nepr.2023.103715
22. Rosa-Castillo A, García-Pañella O, Roselló-Novella A, Maestre-Gonzalez E, Pulpón-Segura A, Icart-Isern T, et al. The effectiveness of an Instagram-based educational game in a Bachelor of Nursing course: An experimental study. Nurse Educ Pract. 2023;70(103656):1-6. doi: 10.1016/j.nepr.2023.103656.
23. Gökdemir F, Yılmaz T. Likert Tipi Ölçekleri Kullanma, Modifiye Etme, Uyarlama ve Geliştirme Süreçleri. Journal of Nursology. 2023;26(2):148-160. doi:10.5152/JANHS.2023.22260
24. Kaynak S, Ergün S, Karadaş 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;69(103618). doi: 10.1016/j.nepr.2023.103618.
25. Cohen J. Statistical power analysis for the behavioral sciences. 2. Baskı. Routledge. 2023.
26. Ahn JA, Kim EM, Lee JE, Kim KA. Diabetes education program for nursing students: a systematic review and meta‐analysis. Nurs Open. 2024;11(12):e70105. doi: 10.1002/nop2.70105.
27. Yalcinturk AA, Babaoglu E, Sipahi AZ, Gures EE, Dogan S. The use of puzzle technique as an active learning method in psychiatric semiology teaching: a randomized controlled study. Perspectives in Psychiatric Care,2024;2024(1): 7014402. Doi. 10.1155/ppc/7014402
28. Joshi PS. Visualization and crossword: In-class exercise-an active learning strategy. Journal of Engineering Education Transformations. 2021;35(2):12-17.
29. Acun A. The Effect of Puzzles on Nursing Students' Learning Concepts Related to Vital Signs: A Randomized Controlled Study. J Nurs Educ. 2024; Dec(10):1-5. doi: 10.3928/01484834-20240723-03. Online ahead of print.
30. Eyüboğlu G, Buldan Ö, Sarıtaş E, Baykara ZG. The Effect of Crossword and Word Search Puzzles on Nursing Students' Parenteral Medication Administration Knowledge: A Randomized Controlled Study. Turkiye Klinikleri J Nurs Sci. 2025;17(1):154-162. doi: 10.5336/nurses.2024-104812