Puzzle-Based Learning on Nursing Students' Parenteral Medication Knowledge and Motivation

Parenteral medication administration is among the fundamental clinical skills of the undergraduate nursing curriculum and is crucial for safe medication management. According to the 2022 National Core Education Program for Nursing (HUÇEP), parenteral medication administration is defined as a mandatory professional competency that nursing students must acquire before graduation (Competency Code: D3). Accordingly, nursing students must integrate their theoretical knowledge of anatomy and pharmacology with technical knowledge and apply it to practice using appropriate methods and techniques in the clinical field. Medication administration is a nursing practice with a high rate of errors in healthcare and can lead to serious clinical consequences that can directly threaten patient safety. Furthermore, this global context also brings with it significant financial losses. According to a report published as part of the World Health Organization (WHO) initiative, "Global Patient Safety Challenge: Medication Without Harm," medication errors account for an annual economic burden of approximately $42 billion. This report does not include specific numerical data on parenteral medication administration; however, it emphasizes that parenteral medication administration carries a higher risk than other routes of administration. Therefore, to minimize the rate of errors resulting from medication errors in general and parenteral medication administration in particular, it is crucial that students possess a strong theoretical foundation, sound psychomotor skills, and a certain level of self-efficacy in their practice. Nursing students' self-efficacy regarding their knowledge and practices regarding medications and medication administration is one of the indicators that nursing education programs have achieved their goals regarding medication administration. In this regard, with the integration of current teaching approaches into nursing education in recent years, game-based learning strategies that make the learning process more active, fun, participatory, and motivating have begun to come to the fore. Among these strategies, crossword puzzles, in particular, are defined as an effective tool for associating complex concepts, learning terminology, increasing knowledge retention, and ensuring student participation. In a randomized controlled study, it was reported that hook and word search puzzles had a statistically significant difference in nursing students' knowledge levels of parenteral drug administration. In another study conducted with nursing students, it was reported that students who used puzzles understood the subject better, felt more competent, and enjoyed the learning process more. Similarly, in the literature, studies conducted with various health sciences students as well as nursing students show that the use of puzzles as an instructional material increases student motivation and interest in the course, makes learning enjoyable, and strengthens retention. However, a review of the literature reveals that studies conducted with the puzzle-based learning approach largely examine the effects on students' knowledge levels. However, two psychosocial factors that are at least as important as knowledge for success in nursing education and clinical practice are self-efficacy perception and motivation to learn. These two concepts support students' intrinsic motivation, increasing their active participation in the learning process, their sense of curiosity, and their willingness to exert effort. A review of the literature reveals no studies evaluating the impact of crossword-based learning activities on parenteral medication administration on nursing students' knowledge, self-efficacy perceptions, and learning motivation. The originality of this study stems from its assessment of not only cognitive gains but also students' psychosocial learning components. Therefore, this study, which is anticipated to contribute to the theoretical and clinical education processes related to parenteral medication administration in nursing, particularly to the nursing literature, aims to evaluate the impact of crossword-based learning activities on nursing students' knowledge, self-efficacy perceptions, and learning motivation.

• Change in Learning Motivation (YÖMÖ-Ü) [Time frame: Baseline (Week 0), Post-Theoretical Training (Week 2), and Final Assessment (Week 10)]
• Change in Self-Efficacy Related to Safe Parenteral Medication Administration [Time frame: Baseline (Week 0) and after clinical practice (Week 10)]