Simulation-Based Versus Traditional Training for Percutaneous Endoscopic Gastrostomy Care in Nursing Students

This study was conducted as a two-arm, parallel-group randomized controlled trial with a pretest-posttest design at a university nursing faculty in Türkiye during the spring semester of the 2025-2026 academic year.

The study population consisted of first-year undergraduate nursing students enrolled in the Fundamentals of Nursing course. Eligible students were aged 18 years or older, were taking the course for the first time, had no previous health-related educational background, and voluntarily provided written informed consent.

A total of 40 students were randomly assigned to the simulation-based training group (n=20) or the traditional demonstration-based training group (n=20). Random allocation was performed by an individual independent of the research team using a random numbers table. To reduce contamination between groups, practical training sessions were conducted at different times.

At baseline, participants completed a personal information form and a 25-item PEG Knowledge Test. All students subsequently received four hours of standardized theoretical instruction covering PEG care, enteral feeding, medication administration, stoma care, and prevention of complications.

The control group received a two-hour laboratory training session in which PEG care, feeding, and medication administration procedures were demonstrated using training models. No simulation-based scenarios were included.

The intervention group participated in a two-hour structured simulation-based training session conducted in a simulation laboratory. Students practiced PEG care, feeding, and medication administration using a simulation mannequin within an interactive clinical scenario.

One week after the practical training sessions, PEG-related knowledge was reassessed using the same 25-item knowledge test. The test was scored from 0 to 100, with higher scores indicating greater knowledge.

Practical skill performance was assessed using an Objective Structured Clinical Examination (OSCE) and a 25-step PEG Skills Checklist. Each step was scored as correctly performed (2 points), incompletely or incorrectly performed (1 point), or not performed (0 points), yielding a total score ranging from 0 to 50. Higher scores indicated better practical skill performance.

The instructors conducting the OSCE assessments were blinded to group allocation. Statistical analyses were performed by an independent statistician using masked group codes.

After completion of data collection, students in the control group were also offered simulation-based training to ensure equal educational opportunities.

Participants in this group (n=20) received four hours of standardized theoretical instruction on percutaneous endoscopic gastrostomy (PEG) care, enteral feeding, and medication administration, followed by a two-hour structured simulation-based training session. The practical training was conducted in a simulation laboratory using a simulation mannequin and an interactive clinical scenario to develop PEG care and procedural skills.

Behavioral: Simulation-Based PEG Training

Participants in this group (n=20) received four hours of standardized theoretical instruction on PEG care, enteral feeding, and medication administration, followed by a two-hour traditional demonstration-based laboratory session. PEG care, feeding, and medication administration procedures were demonstrated using training models without simulation-based clinical scenarios. After completion of outcome assessments, participants were also offered simulation-based training.

Behavioral: Traditional Demonstration-Based PEG Training

Participants received four hours of standardized theoretical instruction on percutaneous endoscopic gastrostomy (PEG) care, enteral feeding, and medication administration. This was followed by a two-hour structured simulation-based training session conducted in a simulation laboratory. Students practiced PEG care, feeding, and medication administration using a simulation mannequin and an interactive clinical scenario designed to support clinical decision-making and practical skill development.

Participants received four hours of standardized theoretical instruction on PEG care, enteral feeding, and medication administration. This was followed by a two-hour traditional demonstration-based laboratory session. The instructor demonstrated PEG care, feeding, and medication administration procedures using training models. No simulation-based clinical scenarios were used during this session. After completion of all outcome assessments, participants were offered simulation-based training.

Time frame: Baseline and one week after practical training

PEG-related knowledge was assessed using the researcher-developed 25-item Percutaneous Endoscopic Gastrostomy (PEG) Knowledge Test. Each correct answer was scored 4 points, and incorrect or unanswered items were scored 0 points. Total scores ranged from 0 to 100, with higher scores indicating better PEG-related knowledge. The outcome was the change in total knowledge score from baseline to one week after training.

Time frame: One week after practical training

Practical skill performance in percutaneous endoscopic gastrostomy (PEG) care was assessed using the researcher-developed 25-item PEG Care Skills Checklist during an Objective Structured Clinical Examination (OSCE). Each procedural step was scored as correctly performed (2 points), incompletely or incorrectly performed (1 point), or not performed (0 points). The 25 item scores were summed to obtain a single total score ranging from 0 to 50, with higher scores indicating better PEG care practical skill performance.

Comparison of the Effectiveness of Simulation-Based and Traditional Teaching Methods in Percutaneous Endoscopic Gastrostomy Care Training: A Randomized Controlled Trial