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IRCT20120414009469N7 IRCT 2026-11-04 Ahvaz University of Medical Sciences Comparative Effects of Simulation-Based Education and Gamification on Nursing Students’ Knowledge, Attitudes, and Performance in Applying the Emergency Severity Index (ESI), Fifth Edition Comparative Effects of Simulation-Based Education and Gamification on Nursing Students’ Knowledge, Attitudes, and Performance in Applying the Emergency Severity Index (ESI), Fifth Edition 2026-11-22 anticipated 72 Pending https://irct.ir/trial/94058 interventional Randomization: Randomized, Blinding: Single blinded, Placebo: Not used, Assignment: Parallel, Purpose: Education/Guidance, Other design features: This study is a three-arm randomized educational trial with a parallel-group design, comparing simulation-based education and gamification-based education with usual education. Outcomes will be assessed at baseline, immediately after the intervention, and one month after the intervention to evaluate the retention of educational effects. To reduce assessment bias, participant performance will be evaluated by an independent assessor who is blinded to group allocation. To minimize potential contamination between groups, educational sessions will be conducted at separate times, Randomization description: Individual randomization will be performed using a 1:1:1 allocation ratio. Permuted block randomization with variable block sizes of 3 and 6 will be used to maintain balance in the number of participants across the three study groups. Randomization will be conducted separately in each of the two academic semesters, with academic semester serving as the stratification factor. In each semester, following sample selection and confirmation of eligibility, participants will be randomly allocated to one of three groups: simulation-based education, gamification-based education, or the control group receiving usual education, with 12 participants assigned to each group per semester. The random allocation sequence will be generated using random-number generation software by an individual independent of intervention delivery and outcome assessment. To ensure allocation concealment and prevent prediction of subsequent group assignments, the allocation sequence will not be accessible to the researcher delivering the interventions until each participant enters the allocation process. Following confirmation of eligibility, obtaining informed consent, and assignment of a study identification code, each participant will be allocated according to the predetermined randomization sequence, Blinding description: Due to the nature of the educational interventions, blinding of participants and the researcher delivering the interventions is not feasible, as participants will be aware of the type of education they receive and the researcher will be responsible for delivering the intervention assigned to each group. However, to reduce assessment bias, participant performance will be evaluated by an independent assessor who is not involved in delivering the educational interventions and is unaware of participants’ group assignments. Each participant will be assigned a study identification code, and information regarding group allocation will not be made available to the assessor. Performance assessment forms will be completed using study identification codes only, without indicating the educational group. The assessor will also remain unaware of participants’ previous assessment results to the extent possible. Therefore, blinding will be implemented at the outcome assessor level to reduce the risk of bias in performance assessment. N/A Hospital Triage Education Using the Emergency Severity Index, Fifth Edition (ESI-V5), in Nursing Students. Intervention 1: Intervention group 1: Students will first receive a 60-minute educational session on the Emergency Severity Index, Fifth Edition hospital triage system. They will then participate in three weekly 60-minute simulation-based training sessions. A total of 12 clinical scenarios, four per session, will be implemented using standardized patients or simulation equipment. Patient information will be provided progressively, and students will be required to assign an appropriate triage level and justify their decisions within 2–3 minutes. Each scenario will be followed by structured feedback and debriefing. Intervention 2: Control group: Students will receive usual theoretical Emergency Nursing education through lectures and discussion. The educational content related to the Emergency Severity Index, Fifth Edition hospital triage system, will be delivered according to the usual curriculum. After completion of the study, the intervention educational materials will be made available to this group. Intervention 3: Intervention group 2: Students will first receive a 60-minute educational session on the Emergency Severity Index, Fifth Edition hospital triage system. They will then participate in three 60-minute interactive gamification-based sessions using PowerPoint and clinical scenarios. A 15-minute orientation will be provided at the beginning. Students will work in teams of 3–4, with assigned roles such as scenario analysis, vital-sign assessment, final triage-level assignment, and timekeeping. Scenarios of varying difficulty will be presented, with points awarded and immediate feedback provided based on students’ responses and triage decisions. No - There is not a plan to make this available Justification or reason for not sharing IPD is Due to participant confidentiality and research data protection requirements, individual participant data will not be shared.
public Loghman Momeni
School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Golestan Highway, Ahvaz, Khuzestan Province, Iran
Ahvaz Iran (Islamic Republic of) ۶۱۳۵۷۱۵۷۹۴ +98 61 3311 0000 loghmanmomeni1999@gmail.com Ahvaz University of Medical Sciences scientific Mohamad Adineh
Ahvaz, Padadshahr, 19th East Street, Omid Complex
Ahvaz Iran (Islamic Republic of) 6184813161 +98 66 1620 0140 Mohadineh@gmail.com Ahvaz University of Medical Sciences Iran (Islamic Republic of) Being an undergraduate nursing student currently enrolled in the theoretical Emergency Nursing course. Having no prior formal instruction in the Emergency Severity Index, Fifth Edition (ESI-V5), before enrollment in the study. Having no previous participation in formal advanced triage training courses or workshops outside the university curriculum. Providing informed consent to participate in the study and agreeing to cooperate throughout the research process. no limit no limit Both Unwillingness to participate in the study and failure to provide informed consent. Behavior Behavior Behavior Intervention group 1: Students will first receive a 60-minute educational session on the Emergency Severity Index, Fifth Edition hospital triage system. They will then participate in three weekly 60-minute simulation-based training sessions. A total of 12 clinical scenarios, four per session, will be implemented using standardized patients or simulation equipment. Patient information will be provided progressively, and students will be required to assign an appropriate triage level and justify their decisions within 2–3 minutes. Each scenario will be followed by structured feedback and debriefing. Control group: Students will receive usual theoretical Emergency Nursing education through lectures and discussion. The educational content related to the Emergency Severity Index, Fifth Edition hospital triage system, will be delivered according to the usual curriculum. After completion of the study, the intervention educational materials will be made available to this group. Intervention group 2: Students will first receive a 60-minute educational session on the Emergency Severity Index, Fifth Edition hospital triage system. They will then participate in three 60-minute interactive gamification-based sessions using PowerPoint and clinical scenarios. A 15-minute orientation will be provided at the beginning. Students will work in teams of 3–4, with assigned roles such as scenario analysis, vital-sign assessment, final triage-level assignment, and timekeeping. Scenarios of varying difficulty will be presented, with points awarded and immediate feedback provided based on students’ responses and triage decisions. Nursing students’ knowledge score in applying the Emergency Severity Index, Fifth Edition hospital triage system. Timepoint: Before the educational intervention, immediately after completion of the educational sessions, and one month after completion of the intervention. Method of measurement: Researcher-developed 30-item multiple-choice knowledge questionnaire on applying the Emergency Severity Index, Fifth Edition hospital triage system. Nursing students’ attitude score toward applying the Emergency Severity Index, Fifth Edition hospital triage system. Timepoint: Before the educational intervention, immediately after completion of the educational sessions, and one month after completion of the intervention. Method of measurement: Researcher-developed 16-item Likert-scale attitude questionnaire on applying the Emergency Severity Index, Fifth Edition hospital triage system. Nursing students’ performance score in applying the Emergency Severity Index, Fifth Edition hospital triage system. Timepoint: Before the educational intervention, immediately after completion of the educational sessions, and one month after completion of the intervention. Method of measurement: Objective Structured Clinical Examination comprising five scenario-based stations, with a performance assessment checklist to evaluate students’ triage-level assignments using the Emergency Severity Index, Fifth Edition hospital triage system. Ahvaz University of Medical Sciences Approved 2026-10-31 Ethics Committee of Ahvaz Jundishapur University of Medical Sciences Ahvaz Jundishapur University of Medical Sciences, Vice-Chancellery for Research, Ethics Committee. Ahvaz Khouzestan Iran (Islamic Republic of)