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

Plain-language 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.

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