This randomized controlled trial evaluated the effect of a patient safety-focused digital microlearning program on nursing students before and during surgical clinical practice.

Nursing students may face patient-safety and clinical decision-making challenges when moving from classroom learning to clinical settings. This study examined whether short, structured, scenario-based digital learning modules could improve patient-safety awareness, clinical error recognition, decision-making under stress, clinical practice readiness, and self-confidence.

Second-year undergraduate nursing students were randomly assigned to either a digital microlearning plus standard education group or a standard education control group. Outcomes were measured at baseline before the program, immediately after the intervention, at the end of the first week of surgical clinical practice, and at the end of the seventh week of surgical clinical practice. Weekly ecological momentary assessment prompts were also used during clinical practice to examine safety-related behavioral transfer.

The transition from classroom-based nursing education to surgical clinical practice is a critical period for patient safety. During this phase, limited clinical experience, increased responsibility, unfamiliar ward routines, and supervisory dynamics may affect students' ability to recognize patient-safety risks, identify clinical errors, prioritize action, and communicate concerns appropriately.

This study was designed as a single-center, parallel-group randomized controlled trial with an explanatory mixed-methods extension. It was conducted at the Faculty of Health Sciences, Department of Nursing, Agri Ibrahim Cecen University. The recruitment frame consisted of second-year undergraduate nursing students registered for the relevant surgical nursing course and preparing to begin surgical clinical practice. Of 111 students registered on the course, 21 were excluded before randomization because of previous course failure or repetition, absenteeism, or other ineligibility. Ninety students were randomized in a 1:1 ratio and analyzed according to the intention-to-treat principle.

Participants were assigned to either a digital microlearning intervention group or a standard education control group. The intervention group received a patient safety-focused digital microlearning program delivered online for seven consecutive days in addition to standard education. The program consisted of short, scenario-based modules lasting approximately 3-5 minutes each. Module content addressed patient identification, medication safety, patient-safety risk recognition, clinical error recognition, prioritization, escalation, and decision-making under stress. The control group received standard patient-safety education as part of the undergraduate nursing curriculum without additional digital microlearning.

Outcome measures were collected at four time points: baseline before the program (T0), immediately after completion of the intervention (T1), at the end of the first week of surgical clinical practice (T2), and at the end of the seventh week of surgical clinical practice (T3). Primary outcomes were patient-safety awareness and clinical error recognition performance. Secondary outcomes included clinical decision-making under stress, clinical practice readiness, clinical self-confidence, behavioral transfer during clinical practice, and acceptability of the digital microlearning program.

During the seven weeks of surgical clinical practice, students also completed weekly ecological momentary assessment prompts on their clinical practice day. These prompts captured patient-safety risk noticing, appropriate response, escalation or supervisor discussion, perceived confidence, stress, and reflective depth. In addition, an explanatory qualitative component was conducted with selected intervention participants to explore how digital microlearning supported clinical readiness and safety-oriented behavior. The qualitative component focused on mechanisms such as scenario recall, cognitive load reduction, confidence to speak up, and implementation conditions.

This study involved an educational intervention only and did not include invasive procedures, drugs, or medical devices. Participation was voluntary, and written informed consent was obtained from all participants. The study was approved by the Agri Ibrahim Cecen University Scientific Research Ethics Committee and was conducted in accordance with ethical principles for research involving human participants.

Inclusion Criteria:

• Second-year undergraduate nursing students
• Enrolled in the Faculty of Health Sciences, Department of Nursing
• Preparing to begin surgical clinical practice for the first time
• Aged 18 years or older
• Willing to participate and able to provide written informed consent

Exclusion Criteria:

• Previous surgical clinical practice experience
• Previous professional nursing or healthcare work experience
• Incomplete baseline assessment
• Declining to participate or withdrawal of consent

Individual participant data will not be shared because the study involves undergraduate student participants and includes questionnaire responses, scenario-based educational performance scores, ecological momentary assessment data, and qualitative information. Sharing individual-level data could compromise participant confidentiality and privacy, particularly within a single-institution educational setting. Study findings will be reported in aggregate form only.

Outcome assessors were blinded to group allocation.