Online Watch-Summarize-Question-Ask Method in Falls Education for Nursing Students

Official title

The Effect of the Online Watch-Summarize-Question-Ask Learning Method on Nursing Students' Knowledge, Skills, Attitudes, and Behaviors Regarding Patient Falls

Overview

This randomized controlled study will evaluate the effectiveness of an online Watch-Summarize-Question-Ask (WSQA) learning method on nursing students' knowledge, skills, attitudes, and behaviors related to patient fall prevention and management. Sixty-six nursing students will be randomly assigned to intervention and control groups. Both groups will receive standard patient safety education, while the intervention group will additionally participate in an online, evidence-based fall prevention training program structured according to the WSQA method, including video-based learning, summarization, question generation, and interactive discussions. Outcomes will be assessed using validated instruments measuring fall management knowledge, self-efficacy, attitudes toward fall prevention, care planning performance, and student satisfaction. The study aims to determine the effectiveness of an innovative educational approach to improve fall prevention competencies and enhance the quality and safety of nursing care.

Detailed description

Objective The aim of this study is to evaluate the effect of an online fall prevention training program, developed based on the Watch-Summarize-Question-Ask instructional strategy, on the knowledge, skills, attitudes, and behaviors of fourth-year undergraduate nursing students. This evaluation will be conducted using the four levels of the Kirkpatrick's Four-Level Evaluation Model, and it aims to comprehensively determine both the learning outcomes of the training and its reflection on clinical practice.

Type of Research This research will be conducted using a randomized controlled experimental design. Participants will be randomly assigned to two groups using the block randomization method.

Location and Time of the Study The study will be conducted at the Faculty of Nursing, İnönü University, between February and June 2026.

Participants/Sample The study population will consist of fourth-year undergraduate nursing participants enrolled in the Nursing Internship Course at the Faculty of Nursing, İnönü University, during the 2025-2026 academic year. Power analysis indicated a minimum sample size of 56 participants; however, considering potential attrition, a total of 66 participants will be recruited. Participants who meet the inclusion criteria will be assigned to the experimental and control groups using a block randomization method. Each group will include 33 participants (Experimental Group = 33; Control Group = 33).

Method / Intervention Participants in both groups will receive the standard patient safety education included in the undergraduate nursing curriculum. In addition, participants in the experimental group will receive an evidence-based fall prevention training delivered through an online learning model structured according to the Watch-Summarize-Question (WSQ) teaching strategy. The intervention will include video-based learning, structured summarization activities, question generation, and interactive online discussion sessions to reinforce learning and promote active participation. The control group will continue with the standard curriculum without receiving the WSQ-based training. Outcomes will be evaluated using validated measurement tools assessing knowledge, skills, attitudes, and behavioral outcomes related to fall management.

Data Collection Tools Participant Information Form: Participants' demographic characteristics, educational background, and access to technological resources required for participation in online learning platforms.

Satisfaction with E-Learning Scale (Turkish version: E-Derslere Yönelik Memnuniyet Ölçeği): The scale consists of 35 items and five subdimensions. The response options are designed as a five-point Likert-type scale scored between 1 and 5.

Falls Management Knowledge Test: This test will be developed by the researcher based on a literature review to assess participants' knowledge levels on falls management and to evaluate the effectiveness of the education on the patient safety knowledge subdimension Scales for Assessing Self-Efficacy: The scale consists of 11 items prepared in a 6-point Likert-type format.

Attitudes of Nurses Toward Falls Prevention Scale (Turkish version: Hemşirelerin Düşmelerin Önlenmesine Yönelik Tutumları Ölçeği): The scale consists of 19 items and 5 subdimensions. The response options are designed as a five-point Likert scale scored between 1 and 5.

Care Plan Evaluation Form: A structured seven-item assessment form developed by the researchers will be used to determine the extent to which students reflect their knowledge and awareness of fall management in their care plans.

Expected Results/Significance The study is expected to determine the effectiveness of the online fall prevention education developed based on the WSQ learning strategy in improving nursing students' knowledge, skills, attitudes, and behaviors regarding fall management. The findings are anticipated to support the integration of structured, evidence-based online teaching methods into nursing education, enhance patient safety awareness, strengthen clinical decision-making skills, and contribute to the quality of nursing care

Interventions

• Behavioral Online Watch Summarize Question Learning Model
  The intervention consists of a structured online fall prevention education program based on the WSQ instructional strategy. Unlike traditional lecture-based education, this intervention integrates active learning components including video-based instruction, structured summarization tasks, student-generated question development, synchronous interactive discussion sessions, and peer-supported learning through an online discussion forum. The program is delivered through a distance education platfo

Primary outcome measures

• Participant Information Form [Time frame: at baseline]
• Satisfaction with E-Learning Scale (Turkish version: E-Derslere Yönelik Memnuniyet Ölçeği) [Time frame: Immediately after completion of the intervention]
• Falls Management Knowledge Test [Time frame: At baseline and immediately after completion of the education program and at least 3 weeks after the training]
• Scales for Assessing Self-Efficacy [Time frame: At baseline and immediately after completion of the education program and at least 3 weeks after the training]
• Attitudes of Nurses Toward Falls Prevention Scale (Turkish version: Hemşirelerin Düşmelerin Önlenmesine Yönelik Tutumları Ölçeği) [Time frame: At baseline and immediately after completion of the education program and at least 3 weeks after the training.]
• Care Plan Evaluation Form [Time frame: At baseline and at least 3 weeks after the training]

Eligibility criteria

Inclusion criteria

• Volunteers from the 4th year students of the Nursing Faculty at İnönü University

Exclusion criteria

• Graduates of high school, associate's degree, or bachelor's degree programs in a health-related field
• Students who have enrolled in the 4th grade for the second time
• Students who do not have the technical means to access the online education platform
• Students who wish to withdraw from the research at any stage
• Students who do not participate in the training sessions
• Students who do not complete the data collection forms

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

Turkey (Türkiye) · 1 center

• Inonu University Faculty of Nursing — Malatya

Publications

• Maddineshat M, Hashemi M, Besharati R, Gholami S, Ghavidel F. The effectiveness of clinical teaching of mental health courses in nursing using clinical supervision and Kirkpatrick's model. Electron Physician. 2018 Jan 25;10(1):6265-6272. doi: 10.19082/6265. eCollection 2018 Jan. PMID 29588829
• Elias S, Taylor K, Jenkins E, Robinson K, Tesfai Y, Han HR. Strategies to improve student engagement in online nursing education: A systematic review. Nurse Educ Today. 2025 Sep;152:106762. doi: 10.1016/j.nedt.2025.106762. Epub 2025 Apr 29. PMID 40334548
• Chang CY, Chung MH, Yang JC. Facilitating nursing students' skill training in distance education via online game-based learning with the watch-summarize-question approach during the COVID-19 pandemic: A quasi-experimental study. Nurse Educ Today. 2022 Feb;109:105256. doi: 10.1016/j.nedt.2021.105256. Epub 2021 Dec 24. PMID 34968932
• De Gagne JC, Randall PS, Koppel PD, Cho E, Blackwood ER, Kang HS. Online learning in nursing education: A 21st century bibliometric analysis. Nurse Educ Today. 2025 Aug;151:106740. doi: 10.1016/j.nedt.2025.106740. Epub 2025 Apr 8. PMID 40222324
• Taskiran G, Eskin Bacaksiz F, Harmanci Seren AK. Psychometric testing of the Turkish version of the Health Professional Education in Patient Safety Survey: H-PEPSSTR. Nurse Educ Pract. 2020 Jan;42:102640. doi: 10.1016/j.nepr.2019.102640. Epub 2019 Nov 1. PMID 31756625
• Kim YM, Yoon YS, Hong HC, Min A. Effects of a patient safety course using a flipped classroom approach among undergraduate nursing students: A quasi-experimental study. Nurse Educ Today. 2019 Aug;79:180-187. doi: 10.1016/j.nedt.2019.05.033. Epub 2019 May 23. PMID 31153088
• Eskici GT, Kanig M, Ugur E, Seren AKH. The Turkish version of the Patient Safety Competency Self-Evaluation Tool: A validity and reliability study. Nurse Educ Pract. 2021 Nov;57:103229. doi: 10.1016/j.nepr.2021.103229. Epub 2021 Oct 13. PMID 34673387
• Fisher M, Kiernan M. Student nurses' lived experience of patient safety and raising concerns. Nurse Educ Today. 2019 Jun;77:1-5. doi: 10.1016/j.nedt.2019.02.015. Epub 2019 Feb 27. PMID 30877869

Identifiers

NCT: NCT07428772 · 2025/8306 · 8306

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗