Active learning-based reinforcement in nursing education: a cluster-randomized controlled trial using Roper, Logan and Tierney's life model

OBJECTIVE: To examine the effect of puzzle-based reinforcement on nursing students' academic achievement and motivation toward instructional materials. METHOD: To conduct a cluster-randomized controlled trial with 70 first-year nursing students allocated to intervention and control groups. Both groups received a 2-hour interactive lecture on Roper, Logan, and Tierney's Life Model. The intervention group completed a one-week puzzle-based reinforcement program, while the control group received no additional intervention. Data were collected using achievement tests and the Instructional Material Motivation Scale and analyzed using paired-samples t-tests, independent-samples t-tests, and regression analysis. RESULTS: Knowledge scores increased in the intervention group, whereas knowledge scores decreased in the control group. Between-group comparisons and regression analysis showed that puzzle-based reinforcement was associated with higher post-test knowledge scores and relatively higher motivation subscale scores compared with the control group (p < 0.01). CONCLUSION: The findings suggest that puzzle-based reinforcement may be a valuable instructional approach, associated with positive learning outcomes and relatively higher motivation toward instructional materials in nursing education. TRIAL REGISTRATION: ClinicalTrials.gov: NCT07090850.