Study Design
The study had a randomized design with a pretest and post-test control group (Clinical Trial Number: 0000-000339492770).
Purpose of the Study
The purposeof the study is to examine the effect of using puzzle technique in teaching psychiatric semiology.
Variables of the Study
Independent variables of the study: The puzzle method.
Dependent variables of the study: Students’ level of knowledge about the psychiatric semiology.
Study Hypothesis
H1: The level of knowledge of the students for whom the puzzle method is used in the teaching of psychiatric semiology is higher than the students who receive traditional education.
Place and Time of the Study
The study was conducted at a foundation university between November and January 2023.
Population and Sample of the Study
The population of the study consisted of 99 students enrolled in the nursing program of a foundation university in the fall semester of the 2022-2023 academic year and receiving the “Psychiatric Nursing” course. In the study, the purpose was to reach the entire universe, not choosing a sample. 90 students who voluntarily agreed to participate in the study constituted the sample of the study. The students forming the sample were assigned to the intervention and control groups by randomization with the help of a generator on the website www.random.org, by numbering according to their order in the student list. Simple randomization method was used in the study (Figure 1).
Inclusion criteria in the study
- Being registered in the nursing department of the university where the study was conducted,
- Receiving the psychiatric nursing course in the fall semester of the 2022-2023 academic year,
- Receiving the Psychiatric Nursing Course for the first time,
- Not having a communication problem at a level that prevents the conversation,
- Being volunteers to participate in the study.
Data Collection Tools
Descriptive Characteristics Form: In this form, which was created by the researchers by scanning the relevant literature, there are five questions including the students’ age, gender, satisfaction of career choice, academic average, and interest in the psychiatric nursing education. They were asked to score their interest in the psychiatric nursing course in the range of 1-10, with the lowest 1 being the highest 10. (interested in the field of pyschiatric nursing course)
Information Form on Psychiatric Semiology: The form was prepared by researchers based on the literature data to determine students’ knowledge levels of concepts used in psychiatric nursing (Boyd, 2008; Soltan and Girguis, 2017; Souza et al., 2021; Voss and Das, 2022). The form was arranged to include 25 of the 84 concepts in the puzzles used in the study. The statement “I agree” was used for concepts considered correct in this form and the statement “I do not agree” was included for the concepts considered to be wrong. There are 15 items true in the form, and there are wrong answers in 10 items. Students were asked to make a mark for each item in the form. When students mark the concepts in the form as correct, they received 4 points. The lowest score that can be obtained from this form is “0” and the highest score is “100”. Opinions of eight independent experts were taken to evaluate the form in terms of language, expression, intelligibility, coverage of the subject, and whether it contains scientific errors. The content validity index obtained from the experts was determined at the level of 97%.
Data Collection
Written permission was obtained from the Ethics Committee to conduct the study, and the students were informed about the study within the scope of the Declaration of Helsinki and their written informed consent was obtained. The “Descriptive Characteristics Form” and “Information Form on Psychiatric Semiology” were applied to the students who accepted to participate in the study. Students who completed the pre-test were assigned to the intervention and control groups with the simple randomization method. Although the students in the intervention group were asked to fill in the puzzles given at the end of the theoretical lesson, the students in the control group were not made to do puzzles.
Preparation and Implementation of the Puzzle
To determine the mental state and psychopathology in psychiatric nursing practices, it is necessary to understand and define the signs and symptoms. For this reason, the patient’s consciousness (8 concepts), memory (10 concepts), attention (8 concepts), considered (12 concepts), emotion (12 concepts), perception (12 concepts), behavior (10 concepts), and speech (12 concepts), were included in a total of 84 concepts in puzzles. While preparing the puzzle used in the study, the puzzle preparation program was used (Picture 1. Crossword Puzzle Maker).
The students in the intervention group were asked to solve a total of 6 puzzles, one puzzle each week. Students were not given time because it was stated in the literature that students were worried about not being able to finish the puzzles and that they should be allowed to check their correct answers (Agarwal and Rao, 2017; Abuelo et al., 2016; Kalkan et al., 2022). The answers that should be in the prepared puzzles covered the theoretical course topics of psychiatric nursing. Students were expected to place the answers in the specified rows and columns in the puzzles. Students were asked to solve the puzzles individually. Also, the answer to each puzzle is reversed on the back page. The researchers guided the students while the students were solving the puzzles.
The students in the intervention and control groups were asked to fill in the “Information Form on Psychiatric Semiology” again after 6 weeks. The students in the intervention group requested a short discussion with the researchers about the concepts in the puzzle after the puzzle application. Then, a discussion was held in the classroom environment for both the intervention and control groups. Puzzles were also distributed to the control group during this discussion. The students in the intervention group discussed their wrong answers with their friends. In the classroom environment, immediate feedback was provided by the instructors for their wrong answers. This method encouraged students to work in groups and at the same time provided the opportunity to evaluate their performance in the group. The students stated that they learned the concepts by having fun using this method. After this discussion, neither the intervention nor the control group was measured.