Peripheral intravenous catheters (PIVCs) are widely used for vascular access and represent one of the most common invasive procedures in hospitalized patients. Despite their clinical utility, PIVCs are associated with various complications, among which phlebitis is one of the most frequent and clinically significant. Phlebitis, characterized by inflammation of the venous wall, may occur during catheterization or within 24-96 hours after catheter removal and is associated with symptoms such as pain, erythema, swelling, and increased local temperature. Reported incidence rates vary widely in the literature, ranging from 1.5% to 80%, indicating a substantial burden on patient safety and healthcare systems.
PIVC-related complications contribute to prolonged hospital stays, increased healthcare costs, delayed treatment, and reduced patient comfort, while also increasing the workload of healthcare professionals. In this context, early recognition of phlebitis and effective clinical decision-making are critical competencies for nursing students. However, traditional teaching approaches that primarily focus on theoretical knowledge may be insufficient to develop these complex clinical skills.
Innovative, learner-centered educational strategies, such as video-based learning and simulation-based education, offer dynamic and interactive learning environments that promote active engagement and experiential learning. Video-based learning enhances accessibility, flexibility, and student engagement, while simulation-based approaches-particularly those involving standardized patients-provide realistic, safe environments for developing clinical, communication, and decision-making skills.
This randomized controlled study aims to evaluate the effectiveness of standardized patient simulation and video-based learning, compared with traditional education, in improving nursing students' ability to recognize PIVC-related phlebitis and enhance their clinical decision-making skills. Secondary outcomes include learning satisfaction and self-confidence.
By integrating evidence-based educational strategies, this study seeks to advance nursing education and contribute to improved patient safety by fostering clinically competent and confident future nurses.
Being a first-year student in the Faculty of Nursing
Being enrolled in the "Fundamentals of Nursing" course for the first time
Being a volunteer to participate in the study
Students reviewing the "Fundamentals of Nursing" course
Students who do not wish to participate in the research
Parallel
Standardized Patient Simulation
BehavioralThis intervention consists of structured, scenario-based training using standardized patients who are trained to consistently portray clinical manifestations of peripheral intravenous catheter (PIVC)-related phlebitis. Participants are required to perform patient assessment, identify clinical signs (e.g., erythema, pain, swelling, warmth), and make appropriate clinical decisions regarding management. The simulation is conducted in a controlled environment and integrates cognitive, psychomotor, and affective learning domains. Each session is followed by a structured debriefing (e.g., PEARLS model) to enhance reflective learning and clinical reasoning.
Video-Based Training
DeviceThis intervention includes structured video-based educational materials developed to demonstrate the recognition and management of PIVC-related phlebitis. The videos present standardized clinical scenarios with visual and auditory cues, including patient symptoms and appropriate nursing interventions. Participants engage with the content in a guided format, allowing for repeated viewing and cognitive rehearsal. The intervention is designed to enhance knowledge acquisition, clinical reasoning, and learner engagement through flexible and accessible learning.
Phlebitis Recognition Knowledge
The level of knowledge regarding the recognition of peripheral intravenous catheter (PIVC)-related phlebitis, including identification of signs and symptoms such as erythema, swelling, pain, and warmth. Measurement Tool: The "Phlebitis Assessment Knowledge Test" was administered to students in both the experimental and control groups before the intervention and after skill performance assessments. The knowledge test consisted of 10 multiple-choice questions prepared by the researcher based on the literature. Expert opinions on the test will be obtained from five faculty members specializing in the Fundamentals of Nursing. The test is scored between 0 and 100. Higher scores indicate a higher level of knowledge in diagnosing and evaluating phlebitis.
Clinical Decision-Making Skills
This scale describes how nursing students perceive clinical decision-making based on their own statements (Jenkins, 2001). The original Clinical Decision-Making Scale for Nursing (CDM) consists of 40 items and four subscales. A reliability and validity study of the CDM in nursing in Turkey was conducted by Durmaz and Dicle (2015). The subscales are, respectively: "Exploring options and ideas", "Investigating goals and values", "Evaluating outcomes", and "Exploring information and adopting new information impartially". Each subscale consists of 10 items. Scores range from 40 to 200 for the total scale and from 10 to 50 for each subscale; there is no cutoff point. A high score indicates a high perception of decision-making, while a low score indicates a low perception of decision-making. The scale is evaluated based on each subscale and the total scale score.
Student Satisfaction and Self-Confidence Scale in Learning
The scale, originally developed by Jeffries and Rizzolo (2006) with 13 items, was adapted into Turkish by Unver et al. (2017) with a total of 12 items (Jeffries \& Rizzolo, 2006; Unver et al., 2017). This scale measures students' satisfaction and self-confidence in learning in a simulation environment. The scale consists of two sub-sections: "Satisfaction with Current Learning" and "Self-Confidence in Learning". The "Satisfaction with Current Learning" sub-section consists of 5 items, and the "Self-Confidence in Learning" sub-section consists of 7 items. The scale is a five-point Likert type, with response options for items expressing student feelings being: 1) Strongly disagree, 2) Disagree, 3) Undecided, 4) Agree, and 5) Strongly agree; there are no negative items. An increase in the score on the scale indicates increased student satisfaction and self-confidence in learning (Unver et al., 2017).
Simulation Design Scale
The scale consists of 5 subscales and 20 items: "Goals and Knowledge", "Support", "Problem Solving", "Feedback/Guided Reflection", and "Accuracy". Developed by Jeffries and Rizzolo (2006), the scale was adapted into Turkish by Unver et al. (2017) (Jeffries \& Rizzolo, 2006; Unver et al., 2017). The scale is scored by dividing the total score given to the answers by the number of items. The lowest possible score on the scale is 1, and the highest is 5. The first section measures whether the best simulation design elements were applied in the simulation application. A high total score on the scale indicates that the best simulation design elements were applied in the simulation application. The second section of the scale measures how important the simulation application is to the students. A high total score on the scale indicates that the student attaches high importance to the simulation experience they have had (Unver et al., 2017).
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Selçuk Görücü
Lead sponsor
Aydin Adnan Menderes University
Sponsor institution
Aydin Adnan Menderes University
Collaborator
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