Virtual Game Simulation Effect on Nursing Students' Knowledge and Skills

The study is a randomized controlled experimental study conducted to determine the effects of a virtual game simulation developed for standard infection precautions on the knowledge and skills of nursing students. The research will be conducted with first-year nursing students studying at the Department of Nursing, Faculty of Health Sciences, Sakarya University, in Turkey, during the Fall Semester of the 2025-2026 Academic Year. In order to conduct the research, written permission was obtained from the Sakarya University Social and Human Sciences Ethics Committee (Date:24.09.2025, Number:90/09) and the Sakarya University Faculty of Health Sciences, where the research will be conducted. In our study, with an effect size of 0.535 obtained from the source article, it was calculated that a total of 112 people, with a minimum of 56 people in each group, were required to study at 80% power and an α=0.05 error level. The G Power 3.1.9.7 package program was used in the sample calculation. In an experimental study, it is stated that keeping losses below 10% or 15% is important for reducing bias, and increasing the sample size is useful in controlling bias due to losses. Therefore, the number of students to be included in the sample was calculated as 130 (Experimental: 65, Control: 65) with a 15% probability of loss. Data in the study will be collected using the "Descriptive Characteristics Form," "Knowledge Test on Standard Infection Precautions," "Skill Checklists on Standard Infection Precautions," and "Self-Debriefing Form." A preliminary application will be conducted with second-year students at the university which the study will be conducted to evaluate the functionality of the data collection forms and the Moodle Learning Management System in the study. Necessary adjustments will be made to the forms and system operation based on the data obtained from the preliminary application. Randomization in determining the sample will be performed using the software program The R Project for Statistical Computing (Windows 2021, R version 4.1.2). Assignment to groups will be made in a way that ensures homogeneity based on gender and nursing department entrance scores.

Students will be divided into two groups: a virtual game simulation (experimental) and a control group, according to the order determined by the principal investigator. The researcher will made a theoretical lesson on standard infection precautions to students in the control group using a PowerPoint presentation using the methods of explanation, question-answer, and discussion. At the end of the lesson, the students will be administered a "Knowledge Test on Standard Infection Precautions" (pre-test) to measure their initial knowledge scores. The next day, students will be taken to the laboratory, where the researcher will demonstrate the skills of "Medical handwashing," "Sterile glove donning and doffing," and "Personal protective equipment donning and doffing" using a demonstration method, following the procedure steps. Subsequently, under the researcher's supervision, all students will be able to perform the specified skills. At the end of the laboratory lesson, students will be informed about the skill assessment to be performed the following day and will be provided with checklists containing the procedure steps for "Medical handwashing," "Sterile glove donning and doffing," and "Personal protective equipment donning and doffing." Students' skills will then be measured. To prevent bias, the researcher will not conduct a skill assessment; skill measurements will be conducted by two independent observers. Observers will not be informed of the students' group status. This will ensure that the observers are blinded to the study. The next day, in the laboratory, the students will be administered the "Skill Checklist for Medical Handwashing," the "Skill Checklist for Donning and Doffing Sterile Gloves," and the "Skill Checklist for Donning and Doffing Personal Protective Equipment" (initial skill assessment). No additional practice will be administered for seven days after the initial data from the control group students are collected. One week later, the students will be administered the "Standard Infection Precautions Knowledge Test" (posttest), and the skills "Medical Handwashing," "Sterile Glove Donning and Doffing," and "Personal Protective Equipment Donning and Doffing" (post-skill assessment) will be administered in the laboratory. After the control group data are collected, the experimental group will be assigned to the experimental group. This will prevent any interaction between the groups.

One week after the theoretical lesson was taught to the control group, the researcher will present a theoretical lesson on standard infection precautions using a PowerPoint presentation using the following methods: a brief explanation, question-answer, and discussion. At the end of the lesson, the students will be administered the "Knowledge Test on Standard Infection Precautions" (pre-test) to measure their initial knowledge scores. The next day, the students will be taken to the laboratory, where the researcher will demonstrate the skills of "Medical hand washing," "Sterile glove donning and doffing," and "Personal protective equipment donning and doffing" using a demonstration method, following the steps outlined. Then, under the researcher's supervision, all students will ensure that the specified skills are performed. At the end of the laboratory lesson, students will be informed about the skill assessment to be conducted the following day and will be provided with checklists containing the steps for "Medical hand washing," "Sterile glove donning and doffing," and "Personal protective equipment donning and doffing." The next day, in the laboratory, students' skills will be assessed by independent observers using the "Skills Checklist for Medical Handwashing," "Skills Checklist for Donning and Doffing Sterile Gloves," and "Skills Checklist for Donning and Doffing Personal Protective Equipment" (initial skill assessment). After the initial knowledge and skills assessment of the experimental group is completed, students in the experimental group will receive a 30-minute PowerPoint presentation in the classroom on how to log in to the Moodle Learning Management System and access the virtual game simulation. The researcher will email the students in the experimental group their username and password to access the virtual game simulation, which will be uploaded to the Moodle platform. Students will have access to the content of the virtual game simulation at their convenience and location for seven days. After all students complete the virtual game simulation, the researcher will ensure that all students in the experimental group complete the "Self-Debriefing Form" uploaded to Moodle. Students in the experimental group who experienced the virtual game simulation will be administered the "Standard Precautions Knowledge Test" (post-test) at the end of seven days, and their skills will be assessed in the laboratory using the "Medical Handwashing Skills Checklist," the "Sterile Glove Donning and Doffing Skills Checklist," and the "Personal Protective Equipment Donning and Doffing Skills Checklist" (post-skill assessment). After the experimental group's implementation is complete, students in the control group will also be able to play and benefit from the virtual game simulation.