ARCS-Based Escape Room Education and Medication Skills in Nursing Students

Effect of an ARCS-Based Escape Room Education on Nursing Students' IV Medication Administration Skills: A Randomized Controlled Trial

This randomized controlled trial aims to evaluate the effect of an ARCS-based escape room educational intervention on nursing students' medication administration knowledge, clinical skills, and learning motivation. Medication administration errors represent a major threat to patient safety, and nursing students must develop safe medication practices early in their education through effective and engaging instructional approaches.

The study will be conducted with first-year undergraduate nursing students enrolled in a Fundamentals of Nursing course at a public university. Participants will be randomly assigned to either an intervention group or a control group. Both groups will receive standard theoretical instruction and laboratory-based training on medication administration. In addition, the intervention group will participate in an ARCS-based escape room activity designed to reinforce medication administration competencies.

The escape room intervention will be structured according to Keller's ARCS Motivation Model (Attention, Relevance, Confidence, Satisfaction) and will include scenario-based learning stations focusing on oral medication administration and parenteral medication administration operationalized as subcutaneous and intravenous routes. Each station will require students to apply medication safety principles, clinical decision-making, and procedural skills within a time-limited, team-based game environment.

Primary outcomes will include medication administration knowledge and clinical skill performance assessed using a structured knowledge test and objective structured clinical examination (OSCE). Learning motivation will be evaluated as a secondary outcome using a validated motivation scale based on the ARCS model. Assessments will be conducted at baseline and after completion of the educational intervention.

The findings of this study are expected to provide evidence regarding the effectiveness of ARCS-based escape room education as an innovative, student-centered instructional strategy for improving medication administration competencies and learning motivation among nursing students.

Medication administration errors constitute a persistent patient safety concern and are frequently associated with insufficient clinical competence, particularly among novice nursing students. Early development of safe medication administration practices requires instructional approaches that integrate cognitive knowledge, psychomotor skill acquisition, and motivational engagement.

This randomized controlled study is designed to examine the effectiveness of an ARCS-based escape room educational intervention integrated into a Fundamentals of Nursing skills laboratory. The intervention is theory-driven and structured according to Keller's ARCS Motivation Model (Attention, Relevance, Confidence, Satisfaction).

The study will employ a parallel-group randomized design. Following baseline assessment, eligible participants will be allocated to either the intervention or control group using a randomization procedure. Both groups will receive standard curriculum-based theoretical instruction and laboratory practice on medication administration prior to group allocation. The intervention will be implemented as an adjunct educational activity following routine laboratory instruction.

Intervention Structure

The escape room intervention will be delivered as a structured, team-based simulation activity conducted in a controlled laboratory environment. The activity will include sequential scenario-based stations representing simulated patient care contexts. The instructional content will focus on oral medication administration and parenteral medication administration operationalized as subcutaneous and intravenous routes.

Each station will require participants to:

Perform medication safety verification processes (e.g., patient identification, dose confirmation, route verification),

Demonstrate procedural sequencing consistent with standardized medication administration protocols,

Apply clinical reasoning to resolve embedded safety-related challenges,

Collaborate within a time-restricted task structure.

The intervention explicitly operationalizes the ARCS framework:

Attention: Time pressure, interactive puzzles, visual cues, and scenario-triggered challenges.

Relevance: Realistic patient cases reflecting early clinical learning contexts.

Confidence: Progressive task complexity, structured facilitation, and immediate corrective feedback.

Satisfaction: Task completion milestones and structured debriefing following the activity.

The intervention will be delivered once during the laboratory period and will be facilitated by trained faculty members to ensure procedural consistency.

Control Condition

Participants allocated to the control group will continue with routine laboratory-based self-directed skills practice using standard training equipment and demonstration models. No gamified or ARCS-structured activities will be implemented for this group during the study period.

Outcome Assessment Framework

Outcome assessments will be conducted at predefined time points. Knowledge assessment will evaluate cognitive understanding of medication administration principles. Clinical performance will be evaluated using standardized performance-based assessment procedures within a structured examination format. Motivation will be examined as an affective outcome associated with instructional design.

The study is designed to determine whether the integration of a theory-driven, gamified educational strategy produces measurable improvements in medication-related competencies beyond standard laboratory education.

This trial aims to contribute empirical evidence regarding structured motivational instructional design within undergraduate nursing education and its potential implications for strengthening safe medication administration competencies.

Inclusion Criteria:

Being a first-year student Taking the Basic Principles and Practices in Nursing course for the first time Voluntarily participating in the study..

Exclusion Criteria:

Being a graduate of a health vocational high school Not participating in theoretical and laboratory training Not completing data collection forms; and Wanting to withdraw from the study.