Does Use of Moulage Affect the Wound Care Skills of Nursing Students?: A Randomised Controlled Trial

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Prof. Dr. Dilek ÇEÇEN ÇAMLI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7031096/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND The use of moulage is a technique that supports the sensory perception of participants and the fidelity of the simulation scenario in nursing education. OBJECTIVES This study aimed to determine the effect of moulage use on developing wound care skills in nursing students. DESIGN AND SETTING: This randomized-controlled study was conducted at the Faculty of Health Sciences at Manisa Celal Bayar University, Manisa, Turkey. METHODS 92 students who met the inclusion criteria participated in the study conducted between October 2021 and January 2022. 'Wound Care Information Form', 'Wound Care and Dressing Skill Form', 'Student Satisfaction and Self-Confidence in Learning Scale' and 'Simulation Design Scale' were used in the study. RESULTS According to the research findings, it was determined that the difference between the wound care knowledge score pre-test and post-test scores was statistically significant and the post-test scores were higher. In the study, it was found that the wound care and dressing skill scores of the students in the intervention group were higher than the scores of the students in the control group and the difference was statistically significant (p < 0.05). It was determined that the mean scores of both scales and subscale scores of the students in the intervention group used in the study were higher and the difference was statistically significant. CONCLUSIONS It was found that the moulage application made a positive contribution to the students' wound care skill scores, students' self-confidence and satisfaction scores, and the simulation design. Clinical trial number Not applicable. simulation nursing education students wound Figures Figure 1 INTRODUCTION Nursing education aims to internalise and transform the knowledge, skills, and attitudes pertaining to the profession into behaviour; therefore, it involves all learning domains (affective, cognitive and psychomotor domains) [ 1 , 2 , 3 ]. The use of visual and audio teaching tools in education is very important for the permanence of learning. It is well recognised that including more sensory organs into the process during teaching activity is essential for providing long-term learning. The vocational education, specifically nursing education, which require to combine theoretical and practical education, highlights that it is very important for students to learn by experiencing and applying [ 4 , 5 ]. The World Health Organisation (WHO) has published a set of fundamental standards for nursing education. In accordance with these standards, the use of simulation and electronic learning techniques is recommended for an effective learning and teaching within nursing schools [ 6 ]. Simulation is a method that develops and supports students’ affective, cognitive and psychomotor skills through the replication of events by imitating possible scenarios within a reliable and real-like setting [ 7 ]. Another technique that supports the participants’ sensory perceptions and the fidelity of the simulated scenario in nursing education is the use of moulage. Moulage, utilised to simulate injury, disease, ageing, and other physical characteristics, can be used alone or incorporated into the simulated scenarios and applied to both the skin of manikins and standardised patients [ 8 , 9 ]. This method aims to improve students’ clinical decision-making skills and improve their self-confidence by providing students with the opportunity to learn through experimentation. On the other hand, students' experience in moulage-assisted education in laboratory before being in an actual patient care setting helps them improve their clinical competencies [ 10 , 11 ]. One of the fundamental nursing practices is wound care. Besides assuming a significant role and bearing responsibility in the wound care and treatment, nurses and nursing students must have an extensive education and knowledge on wounds, wound care, and wound healing and evaluation [ 12 ]. The aim of this study is to determine the effect of moulage application, which is one of the current and technology-based educational techniques presented in the laboratory setting before being experienced on patients in the clinical field, on the clinical skills of students regarding wound evaluation and care. OBJECTIVE This study aimed to determine the effect of moulage use on developing wound care skills in nursing students. Research Questions The following are the questions to which the research seeks an answer: How does the use of moulage affect the wound care knowledge and skills of students? How does the use of moulage affect the satisfaction and self-confidence of the student in the learning process? How much is the design of moulage-assisted simulation training important for the students? METHOD Study design and sample This is a randomised controlled trial. The study was conducted with students enrolled in the nursing department of the faculty over the period spanning from October 2021 to January 2022. The population consisted of 104 second-year students from the Nursing Department who were enrolled in the branch that did not attend the Surgical Diseases Nursing course. Twelve students who did not meet the inclusion criteria (5 students had previously attended the Surgical Diseases Nursing Course, four students had completed an associate degree programme related to medicine, and three students were included in the preliminary study) were excluded from the study and was completed with 92 students including 46 in the intervention group and 46 in the control group. [ Figure 1 ] The sample size was calculated using the t-test in the PASS programme, with reference to the study by Başak et al., (2018) (mean score of the simulation design scale: 4.07 ± 0.52 for the intervention group and 4.62 ± 0.40 for the control group). In the calculation, the minimum required sample size was found to be a total of 90 including 45 in each group, with a power of 0.99 and a significance level of α = 0.001. Ninety two students including 46 in the intervention group and 46 in the control group, were included in the study. The post-hoc power of the study was calculated using the “G. Power-3.1.9.2” programme, and as a result of the analysis applied on 92 participants, the effect size was found to be 0.697 at a level of α = 0.05, and the post-hoc power of the study was calculated as 1.00. Since the minimum power value required for post-hoc analysis was 0.67, it was determined that the power value obtained in the study was at an acceptable level and the number of data was sufficient [ 13 , 14 ]. Inclusion and exclusion criteria Inclusion Criteria The following inclusion criteria were established to determine the eligibility of students assigned to intervention and control groups: Being voluntary to participate in the study, Having receiving no training on wound care before, Being second-year nursing students who were open to communication. Exclusion Criteria Exclusion criteria determined for students in the intervention and control groups were determined as follows: Declining to participate in the study Being graduates of the Health vocational high School who have previously received wound care training and Being graduates of an associate degree programme on health. Dependent and Independent Variables of the Study Dependent Variables : The pre-test and post-test scores of the students who participated in the study on the “Wound Care Knowledge Form,” their scores on the “Wound Care and Dressing Skill,” and their means scores on the “Student Satisfaction and Self-Confidence in Learning Scale” and the “Simulation Design Scale” were the dependent variables of the study. Independent Variables : Socio-demographic characteristics of the students who were included in the study, such as age, gender, and educational background, were the independent variables of the study. Data Collection Tools The following forms were applied to the students who participated in the study: Student Information Form The researchers prepared this form to identify the socio-demographic characteristics of students. The Student Information Form consisted of a total of 11 questions, including the student's personal information, such as age, gender, the most recently graduated school, and status of willingly choosing nursing profession. Wound Care Knowledge Form The form consists of a total of twenty two questions prepared by the researchers upon the literature review to determine students' knowledge and behaviours regarding wound care and evaluation [ 12 , 15 ]. Care Knowledge Form was applied to the students as Pre-test before the theoretical education and as Post-test after the theoretical education and wound care practices were completed. The students were asked to indicate whether the statements provided in the form were accurate or inaccurate by marking either “True” or “False”. The students got one (1 point) for the correct answers and zero (0 point) for the incorrect answers based on the answer key, and the total score of the wound care knowledge form was obtained. The highest score to be obtained from the “Wound Care Knowledge Form” is twenty two points, and its lowest score is zero point. As the score on this form increases, the student's knowledge level elevates. Student Satisfaction and Self-Confidence in Learning Scale Ünver et al., (2015) conducted its Turkish validity and reliability [ 16 ]. The scale consists of two subscales (“Satisfaction with Current Learning/five items, “Self-confidence in Learning”/seven items) and 12 items. A 5-point Likert-type scale contains no negative items. The scores of the scale are calculated by dividing the sum of the subscales by the number of items. As the score of the scale increases, student satisfaction and self-confidence in learning also increases. In this study, it was found that Cronbach’s Alpha coefficient was 0.96 for the overall scale, 0.92 for the Satisfaction with Current Learning subscale and 0.939 for the Self-Confidence in Learning subscale. Simulation Design Scale Ünver et al., (2015) conducted its Turkish validity and reliability study (Ünver et al., 2015). The scale has 20 items and five subscales: “Objectives and Information” (5 items), “Support” (4 items), “Problem Solving” (5 items), “Feedback/Guided Reflection” (4 items), and “Fidelity (Realism)” (2 items). This scale is assessed in two parts: the first part discusses the extent to which the simulation practice incorporates the best simulation design elements, and the second part assesses how important simulation design items are for the students. The responses are scored using a 5-point Likert scale. The first part is assessed on a scale ranging from “1: strongly disagree with the statement” to “5: strongly agree with the statement,” while the second part is assessed on a scale ranging from “1: not important” to “5: very important.” The scores of the scale and its subscales are calculated by dividing the total score or the sum of the scores of the subscales by the number of items. Higher scores indicate greater application of simulation design elements and that simulation design elements are more important for students [ 16 ]. The total Cronbach’s alpha coefficient of the scale was found to be 0.959 for this study. Wound Care and Dressing Skill Assessment Form The form consisted of 27 skills prepared by the researchers based on the existing literature to assess second-year nursing students' wound care and dressing skills 12,15 . To determine the wound care and dressing skill scores, 2 points were given to the practices deemed sufficient according to the "Wound Care and Dressing Skill Form", 1 point was given to the practices that needed to be improved, and 0 point was given to the practices deemed insufficient, and the total score of the skill form was obtained. The highest and lowest scores of the skill form are 54 and 0, respectively. As the score obtained in the wound care and dressing skill form increases, the student's skill level increases. Data Collection Methods After receiving approval from the Manisa Celal Bayar University ethics committee, students who gave written informed consent to participate in this study were selected. The students participating in the study were divided into two groups according to their branches (odd and even numbers) in the hospital clinical practice. The groups were randomly selected from the two branches, and the selected branch was accepted as the intervention group. Branch A was determined as the intervention (moulage training) group, and branch B was determined as the control (low-level simulation) group. Two weeks after the theoretical training, laboratory applications of the intervention and control groups were carried out in the Simulation Laboratory of the Nursing Department of the Faculty of Health Sciences of Manisa Celal Bayar University. Both groups were given preliminary information before starting the training. Before the intervention, both groups filled out the student introduction form. After first receiving theoretical wound care training, both groups were given wound care application training using moulage in the intervention group and simple task-instructive models in the control group. Data Analysis The data obtained in the research were analyzed using the SPSS (Statistical Package for Social Sciences) program. Descriptive statistical methods (number, percentage, minimum-maximum values, mean and standard deviation) were used when evaluating the data. "Reliability Analysis" was performed to test the reliability of the scales. The suitability of the data used for normal distribution was tested. In normally distributed data, independent t-test was used to compare quantitative data for the difference between two independent groups. Homogeneity according to groups was tested with Chi Square analysis. To test the relationship between numerical variables, Pearson correlation coefficient was used for normally distributed data, and Spearman correlation coefficient was used for non-normally distributed data. RESULTS When the gender distribution of the students in the sample group was analysed, it was determined that while 82.6% and 17.4% of the students in the intervention group were female and male, respectively; 87% and 13% of the students in the control group were female and male, respectively. The student groups were homogenously distributed by their gender (p > 0.05). When the students' educational level before their bachelor’s degree was analysed, it was found that 89.1% of the students in the intervention group and 91.3% of the students in the control group graduated from Anatolian High School. The students in both groups were homogenously distributed by their educational levels (p > 0.05) (Table 1 ). When the age distribution of the students was analysed, it was found that while the mean age of the students in the intervention group was 20.09 ± 0.96 (min: 19, max: 22.0), the mean age of the students in the control group was 19.54 ± 0.72 (min: 18, max: 21), and the student groups were not homogenously distributed by their ages (p < 0.05) (Table 1 ). When the students' status of willingly choosing the nursing profession before their bachelor’s degree was analysed, it was found that 39.1% of the students in the intervention group and 41.3% of the students in the control group willingly chose the nursing profession (Table 1 ). The pre-test and post-test mean scores of the students on the Wound Care Knowledge Form were 18.56 ± 1.75 (min:13, max:21) and 20.62 ± 1.18 (min:15, max:22), respectively (Table 2 ). The scores of the students on wound care and dressing skill assessment form were 50.05 ± 2.95 (min:41, max:54). The total mean scores of the ‘‘Student Satisfaction and Self-Confidence in Learning Scale’’ were 4.44 ± 0.45 (min:4, max:5), and their total mean scores on the “Best Design Elements” domain of the ‘‘Simulation Design Scale’’ were 4.49 ± 0.41 (3.81-5.00), and their total mean scores on the “Importance for the Student” domain of the Simulation Design Scale were 4.46 ± 0.44 (3.65-5.00) (Table 2 ). Table 2 Distribution of Students' Scores from Scales and Sub-Dimensions Scale and Sub-Dimensions Mean ± Standard Deviation Min-Max Wound Care Knowledge Score Pretest 18,56 ± 1,75 13,00–21,00 Wound Care Knowledge Score Posttest 20,62 ± 1,18 15,00–22,00 Wound Care and Dressing Skill Points 50,05 ± 2,95 41,00–54,00 Student Satisfaction and Self-Confidence Scale in Learning 4,44 ± 0,45 3,83 − 5,00 Satisfaction with current learning 4,51 ± 0,43 4,00–5,00 Self-Confidence in Learning 4,39 ± 0,48 3,71 − 5,00 Simulation Design Scale (Best Design Elements) 4,49 ± 0,41 3,81 − 5,00 Goals and Information 4,43 ± 0,45 3,20 − 5,00 Support 4,52 ± 0,45 3,75 − 5,00 Problem solving 4,47 ± 0,45 3,60 − 5,00 Feedback/Guided Reflection 4,47 ± 0,48 3,25 − 5,00 Degree of fidelity (Realism) 4,55 ± 0,44 4,00–5,00 Simulation Design Scale (Importance for the Student) 4,46 ± 0,44 3,65 − 5,00 Goals and Information 4,50 ± 0,47 3,80 − 5,00 Support 4,47 ± 0,49 3,25 − 5,00 Problem solving 4,48 ± 0,52 3,60 − 5,00 Feedback/Guided Reflection 4,43 ± 0,46 3,00–5,00 Degree of fidelity (Realism) 4,43 ± 0,48 4,00–5,00 A statistically significant difference was found between the pre-test and post-test wound care knowledge scores of the students in the intervention and control groups (p < 0.05). The post-test wound care knowledge scores of the students in the intervention group were higher than their pre-test scores. The post-test wound care knowledge scores of the students in the control group were higher than their pre-test scores, and a similar significant difference was found between their pre-test and post-test scores (p 0.05) (Table 3 ). Table 3 Distribution of Wound Care Knowledge Scores and Intra-Group and Inter-Group Comparison Tests Scale and Dimensions Intervention Control Test Value 1 p Mean ± Standard Deviation (Min-Max) Mean ± Standard Deviation (Min-Max) Knowledge Score on Wound Care Pretest 18,30 ± 1,50 (13,00–20,00) 17,83 ± 1,68 (13,00–20,00) 0,951 t 0,061 Posttest 20,74 ± 1,10 (15,00–22,00) 20,50 ± 1,26 (14,00–22,00) -0,860 u 0,390 Test Value 2 -4,138 -5,633 p 0,000* 0,000* Wound Care and Dressing Skill Points 4,87 ± 0,29(4,00–5,00) 4,15 \(\:\pm\:\) 0,21(4,00–4,60) 13,669 0,000* Student Satisfaction and Self-Confidence Scale in Learning 4,77 ± 0,33(4,00–5,00) 4,01 \(\:\pm\:\) 0,27 (3,71 − 5,00) 11,847 0,000* Satisfaction with current learning 4,77 ± 0,22(4,16 − 5,00) 4,20 \(\:\pm\:\) 0,34(3,81 − 4,92 9,459 0,000* Self-Confidence in Learning 4,74 ± 0,30(4,00–5,00) 4,11 \(\:\pm\:\) 0,33 (3,20 − 5,00) 9,363 0,000* Simulation Design Scale (Best Design Elements) 4,76 ± 0,33(4,00–5,00) 4,27 \(\:\pm\:\) 0,42 (3,75 − 5,00) 6,098 0,000* Goals and Information 4,77 ± 0,28(4,00–5,00) 4,17 \(\:\pm\:\) 0,37(3,60 − 5,00 8,557 0,000* Support 4,79 ± 0,26(4,00–5,00) 4,14 \(\:\pm\:\) 0,42(3,25 − 5,00) 8,907 0,000* Problem solving 4,79 ± 0,29(4,00–5,00) 4,30 \(\:\pm\:\) 0,42(4,00–5,00) 6,417 0,000* Feedback/Guided Reflection 4,74 ± 0,27(4,00–5,00) 4,18 \(\:\pm\:\) 0,38(3,65 − 5,00) 8,037 0,000* Degree of fidelity (Realism) 4,74 ± 0,30(4,00–5,00) 4,25 \(\:\pm\:\) 0,48(3,80 − 5,00) 5,754 0,000* Simulation Design Scale (Importance for the Student) 4,69 ± 0,40(3,50 − 5,00) 4,25 \(\:\pm\:\) 0,47(3,25 − 5,00) 4,848 0,000 Goals and Information 4,78 ± 0,32(3,80–5,00) 4,18 \(\:\pm\:\) 0,50(3,60 − 5,00) 6,754 0,000* Support 4,72 ± 0,27(4,00–5,00) 4,13 \(\:\pm\:\) 0,42(3,00–5,00) 7,949 0,000* Problem solving 4,78 ± 0,40(4,00–5,00) 4,08 \(\:\pm\:\) 0,24(4,00–5,00) 10,020 0,000* Mean: Arithmetic Mean, SD: Standard deviation, Min: Minimum value, Max: Maximum value Test Value1: independent sample t test Test Value2: Wilcoxon test u: Mann Whitney U test *p < 0.05 A statistically significant difference was found between the students’ Wound Care and Dressing Skill scores and their scores on the Student Satisfaction and Self-Confidence in Learning Scale and its subscales; their scores on the Simulation Design Scale (Best Design Elements) and its subscales; and their scores on the Simulation Design Scale (Importance for the Student) and its subscales according to their groups (p < 0.05). The scores of the students in the intervention group on the Wound Care and Dressing Skill Assessment Form, and their scores on the Student Satisfaction and Self-Confidence in Learning Scale and its subscales; their scores on the Simulation Design Scale (Best Design Elements) and its subscales; and their scores on the Simulation Design Scale (Importance for the Student) and its subscales were higher than those in the control group (Table 3 ). A statistically significant difference was found between the wound care and dressing skill scores of the students in the intervention group, who were trained on moulage-assisted wound care, according to their gender (p < 0.05). The wound care and dressing skill scores of female students were higher than those of their male counterparts. The wound care and dressing skill scores of the students who willingly chose the nursing profession were statistically higher than those who did not (p < 0.05) (Table 4 ). In the control group including students who did not receive moulage-assisted education, no significant correlation was found between age, gender, and status of choosing willingly the profession and the scores obtained from the scales. Table 4 Comparison of Knowledge Scores and Skill Scores Regarding Wound Care of Intervention Group Students According to Some Descriptive Characteristics Variables Knowledge Score on Wound Care Pretest Knowledge Score on Wound Care Posttest Wound Care and Dressing Skill Score Ort ± SS Ort ± SS Ort ± SS Gender Woman 19,26 ± 1,59 20,71 ± 0,96 51,34 ± 1,53 Man 19,5 ± 1,07 20,88 ± 1,73 49,38 ± 2,62 Test Value t -0,401 -1,155 -2,154 p 0,690 0,248 0,031* Age 18–20 19,48 ± 1,48 20,64 ± 1,19 48,98 ± 3,64 21–22 18,85 ± 1,52 21,00 ± 0,82 51,00 ± 1,41 Test Value t 1,307 -0,780 -1,167 p 0,198 0,435 0,243 Willingly choosing the nursing profession Yes 19,39 ± 1,33 21,11 ± 0,76 51,44 ± 2,38 No 19,25 ± 1,62 20,5 ± 1,23 50,71 ± 1,46 Test Value t 0,303 -1,699 -1,982 p 0,764 0,089 0,047* *p < 0.05 t: independent sample t test Mean: Arithmetic Mean, SD: Standard Deviation The Table 5 showed the results of Spearman correlation analysis to establish the correlation between the scores of students in the intervention and control groups on the scales and their subscales and their wound care knowledge scores (post-test) and wound care dressing skill scores. Table 5 Relationship Between Students' Wound Care Knowledge and Skill Scores and Satisfaction and Self-Confidence, Simulation Design Scale Scores Scale and Dimensions Intervention Control Knowledge Score on Wound Care Post-Test Wound Care and Dressing Skill Score Knowledge Score on Wound Care Post-Test Wound Care and Dressing Skill Score Student Satisfaction and Self-Confidence Scale in Learning r s 0,045 0,026 0,034 0,090 p 0,768 0,862 0,821 0,550 Satisfaction with current learning r s 0,074 0,049 0,100 0,056 p 0,623 0,747 0,508 0,713 Self-Confidence in Learning r s 0,052 0,062 0,029 0,140 p 0,733 0,682 0,850 0,355 Simulation Design Scale (Best Design Elements) r s 0,015 0,373* 0,067 0,298* p 0,920 0,011 0,658 0,044 Goals and Information r s 0,129 0,163 0,039 0,291* p 0,391 0,279 0,795 0,050 Support r s 0,036 0,391** 0,068 0,194 p 0,813 0,007 0,655 0,197 Problem solving r s 0,005 0,333* 0,116 0,280 p 0,976 0,024 0,444 0,059 Feedback/Guided Reflection r s 0,075 0,181 0,154 0,248 p 0,619 0,228 0,308 0,096 Degree of fidelity (Realism) r s 0,249 0,337* 0,110 0,286 p 0,095 0,022 0,468 0,054 Simulation Design Scale (Importance for the Student) r s 0,036 0,185 0,052 0,278 p 0,814 0,219 0,729 0,061 Goals and Information r s 0,051 0,068 0,021 0,271 p 0,738 0,655 0,892 0,068 Support r s 0,160 0,049 0,156 0,230 p 0,287 0,747 0,301 0,123 Problem solving r s 0,047 0,115 0,070 0,258 p 0,754 0,447 0,645 0,084 Feedback/Guided Reflection r s 0,031 0,287 0,089 0,244 p 0,839 0,053 0,558 0,102 Degree of fidelity (Realism) r s 0,130 0,087 0,167 0,273 p 0,391 0,566 0,268 0,066 rs : Spearman correlation *p < 0.05 **p < 0.01 No statistically significant correlation was found between the post-test wound care knowledge scores of the students in the intervention and control groups and the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and their subscales (p > 0.05) (Table 5 ). A statistically significant positive moderate correlation was found between the wound care knowledge and dressing skill scores of students in the intervention group and their scores on the Simulation Design Scale (Best Design Elements) (r: 0.373; p < 0.05), and the support (r: 0.391; p < 0.01), problem-solving (r: 0.333; p < 0. 05), fidelity/realism (r: 0.337; p < 0.05) subscales of the Best Design Elements domain of the scale. A statistically weak correlation was found between the Wound Care and Dressing Skill scores of the students in the control group and their domain score on the Simulation Design Scale (Best Design Elements) (r: 0.298; p < 0.05) and their score on the objectives and information subscale of this domain (r: 0.291; p < 0.05) (Table 5 ). DISCUSSION Moulage refers to the simulation of diseases and/or physical symptoms on a standard patient or manikin using visual and tactile cues, such as make-up techniques, to encourage and increase student involvement [ 17 ]. Moulage applications that appeal to several sensory organs such as sight, hearing, and touch create three-dimensional wounds in wound care simulations. This enables students to get a comprehensive understanding of physiology, aetiology, and healing process of wound and foster their wound assessment skills. Moreover, the moulage applications offer students an application experience that is not provided in conventional classroom settings [ 9 , 18 ]. When examining the descriptive characteristics of the students who received moulage-assisted education (intervention group) and those who received classical wound care education (control group), it was determined that both groups were similar (homogeneous) in terms of gender, educational background, and status of willingly choosing the nursing profession (p > 0.05) (Table 1 ). The homogeneity of the two groups is of utmost significance for the avoidance of bias and the elimination of confounding factors. The mean age of the participants was 20.09 ± 0.96 in the intervention group and 19.54 ± 0.72 in the control group, and a statistically significant difference was found between the groups in terms of mean age (p < 0.05) (Table 1 ). However, the inclusion of the students in the intervention and control groups was based on the branches (Branch A and Branch B) formed by the student affairs office of the faculty. Which branch would be included in the intervention group was determined by drawing lots. Therefore, this outcome is considered random. The wound care knowledge and dressing skill scores of the female participants in the intervention group were higher than those of their male counterparts (51.34 ± 1.53). When the studies on nursing students in the literature were analysed, the scores of female students for skills were found to be statistically significant compared to male students [ 19 , 20 ]. Based on these results, it can be asserted that the manipulative skills of female students in the study were higher than those of male students. When the students' status of choosing willingly the nursing profession was analysed, it was observed that 39.1% of the intervention group and 41.3% of the control group willingly chose the nursing profession (Table 4 ). The status of choosing willingly the nursing profession in Turkey has been an issue that has been discussed in many nursing studies. Students who successfully pass a standardised national exam and get a university entrance score choose a profession according to their scores. This may cause the student to get involved in the profession without knowing it and perhaps without liking it. Since the nursing is a profession that requires devotion and compassion, the correlation between status of choosing willingly the profession and some behaviours related to the profession has been investigated in some studies. There are results indicating in the literature that students who choose the profession willingly have higher patient safety attitudes, professional self-confidence, as well as many professional knowledge and skill evaluations [ 21 , 22 ]. This study also revealed that the wound care knowledge and dressing skill scores, the mean scores on the simulation design scale, (Best Design Elements (support, problem-solving, feedback/guided reflection)) were generally higher. No statistically significant difference was found in the intergroup comparisons of the wound care knowledge scores of the students (Table 3 ). The results of national and international studies, which examined how different levels of simulation applications affect students' knowledge levels, differ. In their study, Akhu-Zaheya et al., (2013) found no statistically significant difference between the basic life support knowledge scores of students in both groups with low and high-fidelity simulation applications. The study conducted by Levett-Jones et al., (2011), to analyse the effect of medium and high- fidelity simulation applications on the knowledge acquisition level of students reported no statistically significant difference between the knowledge scores of the students in two groups [ 23 , 24 ]. The literature also contains the related studies that reported a statistically significant difference between the knowledge levels of the intervention and control groups at different levels of simulation. Garg et al., (2019) found a statistically significant difference between the students' knowledge scores in their study on the implementation of images to one group and moulage to the other group for students to know and diagnose skin lesions. The study by Uzelli and Sarı (2018) reported that the knowledge scores of the students who were subjected to hybrid simulation were significantly higher than those who applied low-fidelity simulation [ 25 , 26 ]. Findings of the present study showed that the difference between the pre-test and post-test wound care knowledge scores of the students was statistically significant in intragroup comparisons, and the post-test score was higher for both groups (Table 3 ). This result suggests that both moulage education and classical wound care education contributed to the basic knowledge level of students about wound care and increased their knowledge scores. Likewise, in their study, Sezgünsay and Başak (2020) examined the efficacy of moulage in the development of pressure ulcer evaluation skills in nursing students and determined that the post-test scores of the students in the intervention and control groups were higher than the pre-test scores, and the difference between them was statistically significant. The wound care knowledge and dressing skill scores of the students in the intervention group were higher than scores of those in the control group and the difference between them was statistically significant (p < 0.05) (Table 3 ). This result led to the conclusion that “moulage education is effective in skill development” as a response to the most important question of the study, “How does moulage-assisted education affect the wound care skills of students?”. The basic education provided to both groups on wound care similarly elevated their knowledge levels; however, the students who received moulage-assisted education had more knowledge levels than the students who did not receive moulage-assisted education. The total mean score of the students on the “Student Satisfaction and Self Confidence in Learning Scale” was 4.81 ± 0.29 in the intervention group and 4.07 ± 0.22 in the control group, and when comparing the total mean scores of the intervention and control groups on the “Student Satisfaction and Self-Confidence in Learning Scale” with their mean scores on the “Satisfaction with Current Learning” and “Self-Confidence in Learning” subscales of the scale, it was determined that total and subscale mean scores of the students in the intervention group were statistically significantly higher (Table 3 ). This result showed that the use of moulage in wound care education elevated the level of self-confidence and satisfaction in students. The research questions “How does moulage-assisted education affect student satisfaction?” and “How does moulage-assisted education affect student self-confidence?” were answered positively. It is thought that this result was due to the fact that students can easily apply their skills in high-fidelity settings. When the literature was examined, the related studies reported that the mean scores on the Student Satisfaction and Self-Confidence in Learning Scale were significantly higher in the high-fidelity simulation groups compared to the low-level simulation groups [ 27 , 28 , 29 , 30 , 31 ]. Simulation methods, which create areas most suitable for the real patient care setting and are increasingly used in nursing education, improve students' communication and critical thinking skills, as well as increasing students' satisfaction with learning and self-confidence [ 32 , 33 , 34 ]. The evaluation of the satisfaction and self-confidence of nursing students is crucial as indicators of learning effectiveness. Moreover, the satisfaction levels of university students play an important role in maintaining their motivation. The related studies in the literature have reported that the mean scores of nursing students on satisfaction with simulation applications are high. This study also revealed that the students' satisfaction levels in the moulage application group were high, which is compatible with the studies in the literature [ 35 , 36 , 37 ]. There was a statistically significant and positive correlation between the wound care knowledge and dressing skill scores of the students in the intervention group and their total scores on the Simulation Design scale (best design elements) and their scores on support, problem-solving, and fidelity subscales (Table 5 ). This result led to the conclusion that “The use of moulage positively affects the wound care skills, satisfaction and self-confidence of the students” as a response to the main question of the research, “How does the use of moulage affect the wound care practices of the students?”. It is quite important and useful for nursing education to prepare and implement effective simulations prepared in accordance with the standards and having the necessary simulation design elements and to evaluate their importance according to the student. Consequently, nursing education has been going through rapid development and change. Learning professional skills is very important in nursing education practices. In this regard, the use of simulation in nursing education creates an environment close to the real clinical environment, allowing knowledge and skills to be learned in a safe learning setting, and it is thought that high-fidelity simulations improve student satisfaction and self-confidence. Limitations The nursing students who were currently enrolled in the undergraduate programme at a university were included in the study. Therefore, the results of the study can only be generalised to the students who possess these characteristics. Since the data were collected from the students through face-to-face interview method, the reliability of the data is limited only to the information provided by the interviewees. Conclusion This study, which was conducted to examine the effect of the use of moulage on the knowledge and skill levels of nursing students in wound care education, revealed that the wound care and dressing skill scores of the students in the intervention group as well as the total mean score of the “Student Satisfaction and Self-Confidence in Learning Scale,” and subscale mean scores were higher compared to the students in the control group. The comparison of the scores on the Simulation Design Scale and its subscales indicated that the mean scores of the students in the intervention group were higher. Based on the results of the study, it is recommended To use moulage technique in wound care and dressing skill education of nursing students, To incorporate moulage method into simulation to improve self-confidence and satisfaction of nursing students in skills education, To repeat the study with a larger sample size and different student groups. Declarations Acknowledgments We would like to thank the nursing students who participated of the study. Authors’ contributions: Kara H: data curation (equal), formal analysis (lead), project administration (equal), writing – original draft (lead); Çamlı DÇ: data curation (equal), project administration (equal), writing, review, and editing (lead). All authors have reviewed and approved the final version of the manuscript submitted for publication. Funding This study received no funding. Data availability The datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. Informed voluntary consent form was obtained from the participants. The protocol was approved by the Manisa Celal Bayar University, Medical Faculty Health Sciences of the Ethics Committee (Date November 11, 2020; Number: 20,478,486/638).). Additionally, institutional permission was obtained from the institution where the data was collected. Clinical Trial Number Not applicable Competing interests The authors declare no competing interests Address for correspondence: Havva Kara Department of Nursing, Manisa Celal Bayar University Number: 8/4, 5526 Street, Uncubozköy Neighborhood, Zip code: 45030, Manisa, Tukey. 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Modern moulage: evaluating the use of 3-dimensional prosthetic mimics in a dermatology teaching program for second-year medical students. Arch Dermatol . 2010; 146(2); 143-6. Uzelli Yılmaz D, Sarı D. The Use of Moulage for Providing “Fidelity” in Nursing Education. Florence Nightingale Journal Of Nursing. 2018; 26 (2): 141 – 148. Wang PH, Huang BS, Horng HC, Yeh CC, Chen YJ. Wound healing. J Chin Med Assoc . 2018, 81(2): 94-101. https://doi: 10.1016/j.jcma.2017.11.002. Basak, T., Unver, V., Moss, J., Watts, P., Gaioso, V. Beginning and advanced students’ perceptions of the use of low- and high-fidelity mannequins in nursing simulation. Nurse Educ. Today. 2016; 36 : 37–43. https://doi.org/10.1016/j.nedt.2015.07.020. Ahmed, M.A. & Mohamed, S.M. Sim-Lab versus traditional lab training on maternity nursing students’ satisfaction & self-confidence. IOSR Journal of Nursing and Health Science. 2016; 5(2): 108-115. Omer, T. Nursing Students’ Perceptions of Satisfaction and Self-Confidence with Clinical Simulation Experience. Journal of Education and Practice. 2016; 7(5): 131-138. Tamaki, T., Inumaru, A., Yokoi, Y., et al. The Effectiveness of end-of-life care simulation in undergraduate nursing education: A randomized controlled trial. Nurse Education Today. 2019; 76: 1-7. Adamson, K. A systematic review of the literature related to the NLN/Jeffries simulation framework. Nursing Education Perspectives. 2015; 36 (5): 281-291. La Cerra, C., Dante, A., Caponnetto, V., et al. Effects of highfidelity simulation based on life-threatening clinical condition scenarios on learning outcomes of undergraduate and postgraduate nursing students: a systematic review and meta-analysis. BMJ Open. 2019; 9(2): e025306. https://doi.org/10.1136/bmjopen-2018-025306 Sarı, D., & Erdem, H. The use of high-fidelity simulation in nursing education: A literature review. 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Nurse Education Today. 2018; 60: 28-34. https://www.sciencedirect.com/science/article/pii/S0260691717302162?via%3Dihub. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7031096","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515786242,"identity":"5830289e-a36d-456c-b6c0-c278887f7996","order_by":0,"name":"Havva KARA","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACAzB5AIjZ2w8+AFI8fMRr4TmTDOLwsBGvRSLBTALEJqjFnP2MmcSPM3b5/D0H0iq/5tjJsDEwP3x0A48Wy54cM8meG8mWM443Hrstuy0Z6DA2Y+McfA47kJZswPOB2YDhzIG025LbmIFaeNik8Wo5/yzZ8M+HegP5GwlmxZLb6onQciP54GOeG4cNDIBaGD9uO0yMlscHH8ucOW5geOZMsjTjtuM8bMyE/HI+seHgm2PVBnLH2w9+/Lmt2p6fvfnhY3xaUAAzD5gkVjkIMP4gRfUoGAWjYBSMGAAAk1NNaIiNl+MAAAAASUVORK5CYII=","orcid":"","institution":"Manisa Celal Bayar University","correspondingAuthor":true,"prefix":"","firstName":"Havva","middleName":"","lastName":"KARA","suffix":""},{"id":515786244,"identity":"cc52f536-934f-4291-9b93-cc16b5682377","order_by":1,"name":"Asist. Prof. Dr. Dilek ÇEÇEN ÇAMLI","email":"","orcid":"","institution":"Manisa Celal Bayar University","correspondingAuthor":false,"prefix":"","firstName":"Asist.","middleName":"Prof. Dr. Dilek ÇEÇEN","lastName":"ÇAMLI","suffix":""}],"badges":[],"createdAt":"2025-07-02 15:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7031096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7031096/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91526879,"identity":"e34a04d2-e270-4f3d-8564-74ca120d274b","added_by":"auto","created_at":"2025-09-17 11:12:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":227338,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7031096/v1/e0e356775525c94f95a793f1.png"},{"id":104083903,"identity":"308f5ce3-7779-4520-b251-f9b37dcd4434","added_by":"auto","created_at":"2026-03-06 14:56:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1622436,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7031096/v1/0cf939e9-9d93-4a2f-a91a-f4713b1c9eca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Does Use of Moulage Affect the Wound Care Skills of Nursing Students?: A Randomised Controlled Trial","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eNursing education aims to internalise and transform the knowledge, skills, and attitudes pertaining to the profession into behaviour; therefore, it involves all learning domains (affective, cognitive and psychomotor domains) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The use of visual and audio teaching tools in education is very important for the permanence of learning. It is well recognised that including more sensory organs into the process during teaching activity is essential for providing long-term learning. The vocational education, specifically nursing education, which require to combine theoretical and practical education, highlights that it is very important for students to learn by experiencing and applying [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe World Health Organisation (WHO) has published a set of fundamental standards for nursing education. In accordance with these standards, the use of simulation and electronic learning techniques is recommended for an effective learning and teaching within nursing schools [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Simulation is a method that develops and supports students’ affective, cognitive and psychomotor skills through the replication of events by imitating possible scenarios within a reliable and real-like setting [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Another technique that supports the participants’ sensory perceptions and the fidelity of the simulated scenario in nursing education is the use of moulage. Moulage, utilised to simulate injury, disease, ageing, and other physical characteristics, can be used alone or incorporated into the simulated scenarios and applied to both the skin of manikins and standardised patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This method aims to improve students’ clinical decision-making skills and improve their self-confidence by providing students with the opportunity to learn through experimentation. On the other hand, students' experience in moulage-assisted education in laboratory before being in an actual patient care setting helps them improve their clinical competencies [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOne of the fundamental nursing practices is wound care. Besides assuming a significant role and bearing responsibility in the wound care and treatment, nurses and nursing students must have an extensive education and knowledge on wounds, wound care, and wound healing and evaluation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The aim of this study is to determine the effect of moulage application, which is one of the current and technology-based educational techniques presented in the laboratory setting before being experienced on patients in the clinical field, on the clinical skills of students regarding wound evaluation and care.\u003c/p\u003e\u003cp\u003eOBJECTIVE\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the effect of moulage use on developing wound care skills in nursing students.\u003c/p\u003e\n\u003cp id=\"_Toc100579368\"\u003eResearch Questions\u003c/p\u003e\n\u003cp\u003eThe following are the questions to which the research seeks an answer:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eHow does the use of moulage affect the wound care knowledge and skills of students?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHow does the use of moulage affect the satisfaction and self-confidence of the student in the learning process?\u003c/li\u003e\n \u003cli\u003eHow much is the design of moulage-assisted simulation training important for the students?\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"METHOD","content":"\u003cp\u003eStudy design and sample\u003c/p\u003e\u003cp\u003eThis is a randomised controlled trial. The study was conducted with students enrolled in the nursing department of the faculty over the period spanning from October 2021 to January 2022. The population consisted of 104 second-year students from the Nursing Department who were enrolled in the branch that did not attend the Surgical Diseases Nursing course. Twelve students who did not meet the inclusion criteria (5 students had previously attended the Surgical Diseases Nursing Course, four students had completed an associate degree programme related to medicine, and three students were included in the preliminary study) were excluded from the study and was completed with 92 students including 46 in the intervention group and 46 in the control group.\u003c/p\u003e\u003cp\u003e\u003cb\u003e[\u003c/b\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e]\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample size was calculated using the t-test in the PASS programme, with reference to the study by Başak et al., (2018) (mean score of the simulation design scale: 4.07 ± 0.52 for the intervention group and 4.62 ± 0.40 for the control group). In the calculation, the minimum required sample size was found to be a total of 90 including 45 in each group, with a power of 0.99 and a significance level of α = 0.001. Ninety two students including 46 in the intervention group and 46 in the control group, were included in the study.\u003c/p\u003e\u003cp\u003eThe post-hoc power of the study was calculated using the “G. Power-3.1.9.2” programme, and as a result of the analysis applied on 92 participants, the effect size was found to be 0.697 at a level of α = 0.05, and the post-hoc power of the study was calculated as 1.00. Since the minimum power value required for post-hoc analysis was 0.67, it was determined that the power value obtained in the study was at an acceptable level and the number of data was sufficient [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion and exclusion criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe following inclusion criteria were established to determine the eligibility of students assigned to intervention and control groups:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBeing voluntary to participate in the study,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHaving receiving no training on wound care before,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBeing second-year nursing students who were open to communication.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eExclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eExclusion criteria determined for students in the intervention and control groups were determined as follows:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDeclining to participate in the study\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBeing graduates of the Health vocational high School who have previously received wound care training and\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eBeing graduates of an associate degree programme on health.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eDependent and Independent Variables of the Study\u003c/b\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eDependent Variables\u003c/b\u003e: The pre-test and post-test scores of the students who participated in the study on the “Wound Care Knowledge Form,” their scores on the “Wound Care and Dressing Skill,” and their means scores on the “Student Satisfaction and Self-Confidence in Learning Scale” and the “Simulation Design Scale” were the dependent variables of the study.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eIndependent Variables\u003c/b\u003e: Socio-demographic characteristics of the students who were included in the study, such as age, gender, and educational background, were the independent variables of the study.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eData Collection Tools\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe following forms were applied to the students who participated in the study:\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudent Information Form\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe researchers prepared this form to identify the socio-demographic characteristics of students. The Student Information Form consisted of a total of 11 questions, including the student's personal information, such as age, gender, the most recently graduated school, and status of willingly choosing nursing profession.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWound Care Knowledge Form\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe form consists of a total of twenty two questions prepared by the researchers upon the literature review to determine students' knowledge and behaviours regarding wound care and evaluation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Care Knowledge Form was applied to the students as Pre-test before the theoretical education and as Post-test after the theoretical education and wound care practices were completed. The students were asked to indicate whether the statements provided in the form were accurate or inaccurate by marking either “True” or “False”. The students got one (1 point) for the correct answers and zero (0 point) for the incorrect answers based on the answer key, and the total score of the wound care knowledge form was obtained. The highest score to be obtained from the “Wound Care Knowledge Form” is twenty two points, and its lowest score is zero point. As the score on this form increases, the student's knowledge level elevates.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudent Satisfaction and Self-Confidence in Learning Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eÜnver et al., (2015) conducted its Turkish validity and reliability [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The scale consists of two subscales (“Satisfaction with Current Learning/five items, “Self-confidence in Learning”/seven items) and 12 items. A 5-point Likert-type scale contains no negative items. The scores of the scale are calculated by dividing the sum of the subscales by the number of items. As the score of the scale increases, student satisfaction and self-confidence in learning also increases. In this study, it was found that Cronbach’s Alpha coefficient was 0.96 for the overall scale, 0.92 for the Satisfaction with Current Learning subscale and 0.939 for the Self-Confidence in Learning subscale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSimulation Design Scale\u003c/b\u003e\u003c/p\u003e\u003cp\u003eÜnver et al., (2015) conducted its Turkish validity and reliability study (Ünver et al., 2015). The scale has 20 items and five subscales: “Objectives and Information” (5 items), “Support” (4 items), “Problem Solving” (5 items), “Feedback/Guided Reflection” (4 items), and “Fidelity (Realism)” (2 items). This scale is assessed in two parts: the first part discusses the extent to which the simulation practice incorporates the best simulation design elements, and the second part assesses how important simulation design items are for the students. The responses are scored using a 5-point Likert scale. The first part is assessed on a scale ranging from “1: strongly disagree with the statement” to “5: strongly agree with the statement,” while the second part is assessed on a scale ranging from “1: not important” to “5: very important.” The scores of the scale and its subscales are calculated by dividing the total score or the sum of the scores of the subscales by the number of items. Higher scores indicate greater application of simulation design elements and that simulation design elements are more important for students [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The total Cronbach’s alpha coefficient of the scale was found to be 0.959 for this study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eWound Care and Dressing Skill Assessment Form\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe form consisted of 27 skills prepared by the researchers based on the existing literature to assess second-year nursing students' wound care and dressing skills\u003csup\u003e12,15\u003c/sup\u003e. To determine the wound care and dressing skill scores, 2 points were given to the practices deemed sufficient according to the \"Wound Care and Dressing Skill Form\", 1 point was given to the practices that needed to be improved, and 0 point was given to the practices deemed insufficient, and the total score of the skill form was obtained. The highest and lowest scores of the skill form are 54 and 0, respectively. As the score obtained in the wound care and dressing skill form increases, the student's skill level increases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003e After receiving approval from the Manisa Celal Bayar University ethics committee, students who gave written informed consent to participate in this study were selected. The students participating in the study were divided into two groups according to their branches (odd and even numbers) in the hospital clinical practice. The groups were randomly selected from the two branches, and the selected branch was accepted as the intervention group. Branch A was determined as the intervention (moulage training) group, and branch B was determined as the control (low-level simulation) group.\u003c/p\u003e\u003cp\u003eTwo weeks after the theoretical training, laboratory applications of the intervention and control groups were carried out in the Simulation Laboratory of the Nursing Department of the Faculty of Health Sciences of Manisa Celal Bayar University. Both groups were given preliminary information before starting the training.\u003c/p\u003e\u003cp\u003eBefore the intervention, both groups filled out the student introduction form. After first receiving theoretical wound care training, both groups were given wound care application training using moulage in the intervention group and simple task-instructive models in the control group.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eThe data obtained in the research were analyzed using the SPSS (Statistical Package for Social Sciences) program. Descriptive statistical methods (number, percentage, minimum-maximum values, mean and standard deviation) were used when evaluating the data. \"Reliability Analysis\" was performed to test the reliability of the scales. The suitability of the data used for normal distribution was tested. In normally distributed data, independent t-test was used to compare quantitative data for the difference between two independent groups. Homogeneity according to groups was tested with Chi Square analysis. To test the relationship between numerical variables, Pearson correlation coefficient was used for normally distributed data, and Spearman correlation coefficient was used for non-normally distributed data.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWhen the gender distribution of the students in the sample group was analysed, it was determined that while 82.6% and 17.4% of the students in the intervention group were female and male, respectively; 87% and 13% of the students in the control group were female and male, respectively. The student groups were homogenously distributed by their gender (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003cp\u003eWhen the students\u0026apos; educational level before their bachelor\u0026rsquo;s degree was analysed, it was found that 89.1% of the students in the intervention group and 91.3% of the students in the control group graduated from Anatolian High School. The students in both groups were homogenously distributed by their educational levels (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eWhen the age distribution of the students was analysed, it was found that while the mean age of the students in the intervention group was 20.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 (min: 19, max: 22.0), the mean age of the students in the control group was 19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72 (min: 18, max: 21), and the student groups were not homogenously distributed by their ages (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/div\u003e\n\u003c/div\u003e\n\u003cp\u003eWhen the students\u0026apos; status of willingly choosing the nursing profession before their bachelor\u0026rsquo;s degree was analysed, it was found that 39.1% of the students in the intervention group and 41.3% of the students in the control group willingly chose the nursing profession (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe pre-test and post-test mean scores of the students on the Wound Care Knowledge Form were 18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75 (min:13, max:21) and 20.62\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 (min:15, max:22), respectively (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The scores of the students on wound care and dressing skill assessment form were 50.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95 (min:41, max:54). The total mean scores of the \u0026lsquo;\u0026lsquo;Student Satisfaction and Self-Confidence in Learning Scale\u0026rsquo;\u0026rsquo; were 4.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45 (min:4, max:5), and their total mean scores on the \u0026ldquo;Best Design Elements\u0026rdquo; domain of the \u0026lsquo;\u0026lsquo;Simulation Design Scale\u0026rsquo;\u0026rsquo; were 4.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 (3.81-5.00), and their total mean scores on the \u0026ldquo;Importance for the Student\u0026rdquo; domain of the Simulation Design Scale were 4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 (3.65-5.00) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of Students\u0026apos; Scores from Scales and Sub-Dimensions\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScale and Sub-Dimensions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMin-Max\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care Knowledge Score Pretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,56\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;1,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,00\u0026ndash;21,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care Knowledge Score Posttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,62\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;1,18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,00\u0026ndash;22,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care and Dressing Skill Points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50,05\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;2,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41,00\u0026ndash;54,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudent Satisfaction and Self-Confidence Scale in Learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,44\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,83\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSatisfaction with current learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,51\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,00\u0026ndash;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Confidence in Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,39\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,71\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Best Design Elements)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,49\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,81\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,43\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,20\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,52\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,75\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,47\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,60\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeedback/Guided Reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,47\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,25\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree of fidelity (Realism)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,55\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,00\u0026ndash;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Importance for the Student)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,46\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,65\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,50\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,80\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,47\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,25\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,48\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,60\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFeedback/Guided Reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,43\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3,00\u0026ndash;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDegree of fidelity (Realism)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,43\u0026thinsp;\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u0026thinsp;0,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,00\u0026ndash;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was found between the pre-test and post-test wound care knowledge scores of the students in the intervention and control groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The post-test wound care knowledge scores of the students in the intervention group were higher than their pre-test scores. The post-test wound care knowledge scores of the students in the control group were higher than their pre-test scores, and a similar significant difference was found between their pre-test and post-test scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, no statistically significant difference was found between the pre-test and post-test wound care knowledge scores between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDistribution of Wound Care Knowledge Scores and Intra-Group and Inter-Group Comparison Tests\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eScale and Dimensions\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTest Value\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e\n \u003cp\u003e(Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e\n \u003cp\u003e(Min-Max)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge Score on Wound Care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePretest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,30\u0026thinsp;\u0026plusmn;\u0026thinsp;1,50 (13,00\u0026ndash;20,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,83\u0026thinsp;\u0026plusmn;\u0026thinsp;1,68 (13,00\u0026ndash;20,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,951\u003csup\u003et\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePosttest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,74\u0026thinsp;\u0026plusmn;\u0026thinsp;1,10 (15,00\u0026ndash;22,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,50\u0026thinsp;\u0026plusmn;\u0026thinsp;1,26 (14,00\u0026ndash;22,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,860\u003csup\u003eu\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Value\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-4,138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-5,633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,000*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eWound Care and Dressing Skill Points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,87\u0026thinsp;\u0026plusmn;\u0026thinsp;0,29(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,15\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,21(4,00\u0026ndash;4,60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudent Satisfaction and Self-Confidence Scale in Learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,77\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,01\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,27 (3,71\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,847\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSatisfaction with current learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,77\u0026thinsp;\u0026plusmn;\u0026thinsp;0,22(4,16\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,20\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,34(3,81\u0026thinsp;\u0026minus;\u0026thinsp;4,92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSelf-Confidence in Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,74\u0026thinsp;\u0026plusmn;\u0026thinsp;0,30(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,11\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,33 (3,20\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Best Design Elements)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,76\u0026thinsp;\u0026plusmn;\u0026thinsp;0,33(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,27\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,42 (3,75\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,77\u0026thinsp;\u0026plusmn;\u0026thinsp;0,28(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,17\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,37(3,60\u0026thinsp;\u0026minus;\u0026thinsp;5,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,79\u0026thinsp;\u0026plusmn;\u0026thinsp;0,26(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,14\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,42(3,25\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,79\u0026thinsp;\u0026plusmn;\u0026thinsp;0,29(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,30\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,42(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eFeedback/Guided Reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,74\u0026thinsp;\u0026plusmn;\u0026thinsp;0,27(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,18\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,38(3,65\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDegree of fidelity (Realism)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,74\u0026thinsp;\u0026plusmn;\u0026thinsp;0,30(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,25\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,48(3,80\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Importance for the Student)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,69\u0026thinsp;\u0026plusmn;\u0026thinsp;0,40(3,50\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,25\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,47(3,25\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,848\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,78\u0026thinsp;\u0026plusmn;\u0026thinsp;0,32(3,80\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,18\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,50(3,60\u0026thinsp;\u0026minus;\u0026thinsp;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,72\u0026thinsp;\u0026plusmn;\u0026thinsp;0,27(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,13\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,42(3,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,78\u0026thinsp;\u0026plusmn;\u0026thinsp;0,40(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,08\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\pm\\:\\)\u003c/span\u003e\u003c/span\u003e0,24(4,00\u0026ndash;5,00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cem\u003eMean: Arithmetic Mean, SD: Standard deviation, Min: Minimum value, Max: Maximum value Test Value1: independent sample t test Test Value2: Wilcoxon test u: Mann Whitney U test *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was found between the students\u0026rsquo; Wound Care and Dressing Skill scores and their scores on the Student Satisfaction and Self-Confidence in Learning Scale and its subscales; their scores on the Simulation Design Scale (Best Design Elements) and its subscales; and their scores on the Simulation Design Scale (Importance for the Student) and its subscales according to their groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The scores of the students in the intervention group on the Wound Care and Dressing Skill Assessment Form, and their scores on the Student Satisfaction and Self-Confidence in Learning Scale and its subscales; their scores on the Simulation Design Scale (Best Design Elements) and its subscales; and their scores on the Simulation Design Scale (Importance for the Student) and its subscales were higher than those in the control group (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA statistically significant difference was found between the wound care and dressing skill scores of the students in the intervention group, who were trained on moulage-assisted wound care, according to their gender (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The wound care and dressing skill scores of female students were higher than those of their male counterparts. The wound care and dressing skill scores of the students who willingly chose the nursing profession were statistically higher than those who did not (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e). In the control group including students who did not receive moulage-assisted education, no significant correlation was found between age, gender, and status of choosing willingly the profession and the scores obtained from the scales.\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Knowledge Scores and Skill Scores Regarding Wound Care of Intervention Group Students According to Some Descriptive Characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge Score on Wound Care Pretest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge Score on Wound Care Posttest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care and Dressing Skill Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrt\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrt\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrt\u0026thinsp;\u0026plusmn;\u0026thinsp;SS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWoman\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,26\u0026thinsp;\u0026plusmn;\u0026thinsp;1,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,71\u0026thinsp;\u0026plusmn;\u0026thinsp;0,96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51,34\u0026thinsp;\u0026plusmn;\u0026thinsp;1,53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,5\u0026thinsp;\u0026plusmn;\u0026thinsp;1,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,88\u0026thinsp;\u0026plusmn;\u0026thinsp;1,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49,38\u0026thinsp;\u0026plusmn;\u0026thinsp;2,62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Value\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1,155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-2,154\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,248\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,031*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,48\u0026thinsp;\u0026plusmn;\u0026thinsp;1,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,64\u0026thinsp;\u0026plusmn;\u0026thinsp;1,19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48,98\u0026thinsp;\u0026plusmn;\u0026thinsp;3,64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u0026ndash;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,85\u0026thinsp;\u0026plusmn;\u0026thinsp;1,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,00\u0026thinsp;\u0026plusmn;\u0026thinsp;0,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51,00\u0026thinsp;\u0026plusmn;\u0026thinsp;1,41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Value\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0,780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1,167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eWillingly choosing the nursing profession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,39\u0026thinsp;\u0026plusmn;\u0026thinsp;1,33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21,11\u0026thinsp;\u0026plusmn;\u0026thinsp;0,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51,44\u0026thinsp;\u0026plusmn;\u0026thinsp;2,38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,25\u0026thinsp;\u0026plusmn;\u0026thinsp;1,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,5\u0026thinsp;\u0026plusmn;\u0026thinsp;1,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50,71\u0026thinsp;\u0026plusmn;\u0026thinsp;1,46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest Value\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1,699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e-1,982\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,047*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 t: independent sample t test Mean: Arithmetic Mean, SD: Standard Deviation\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThe Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e showed the results of Spearman correlation analysis to establish the correlation between the scores of students in the intervention and control groups on the scales and their subscales and their wound care knowledge scores (post-test) and wound care dressing skill scores.\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship Between Students\u0026apos; Wound Care Knowledge and Skill Scores and Satisfaction and Self-Confidence, Simulation Design Scale Scores\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eScale and Dimensions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIntervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge Score on Wound Care Post-Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care and Dressing Skill Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge Score on Wound Care Post-Test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWound Care and Dressing Skill Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudent Satisfaction and Self-Confidence Scale in Learning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,026\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,550\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSatisfaction with current learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,713\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSelf-Confidence in Learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,355\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Best Design Elements)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,373*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,298*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,920\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,291*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,391**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,333*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,280\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFeedback/Guided Reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,619\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,096\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDegree of fidelity (Realism)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,249\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,337*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,286\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eSimulation Design Scale (Importance for the Student)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,278\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,729\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGoals and Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,068\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSupport\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProblem solving\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,447\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,084\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eFeedback/Guided Reflection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,287\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,089\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDegree of fidelity (Realism)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003er\u003csub\u003es\u003c/sub\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,273\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cem\u003ers : Spearman correlation *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 **p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant correlation was found between the post-test wound care knowledge scores of the students in the intervention and control groups and the Student Satisfaction and Self-Confidence in Learning Scale, Simulation Design Scale, and their subscales (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA statistically significant positive moderate correlation was found between the wound care knowledge and dressing skill scores of students in the intervention group and their scores on the Simulation Design Scale (Best Design Elements) (r: 0.373; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the support (r: 0.391; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), problem-solving (r: 0.333; p\u0026thinsp;\u0026lt;\u0026thinsp;0. 05), fidelity/realism (r: 0.337; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) subscales of the Best Design Elements domain of the scale. A statistically weak correlation was found between the Wound Care and Dressing Skill scores of the students in the control group and their domain score on the Simulation Design Scale (Best Design Elements) (r: 0.298; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and their score on the objectives and information subscale of this domain (r: 0.291; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMoulage refers to the simulation of diseases and/or physical symptoms on a standard patient or manikin using visual and tactile cues, such as make-up techniques, to encourage and increase student involvement [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Moulage applications that appeal to several sensory organs such as sight, hearing, and touch create three-dimensional wounds in wound care simulations. This enables students to get a comprehensive understanding of physiology, aetiology, and healing process of wound and foster their wound assessment skills. Moreover, the moulage applications offer students an application experience that is not provided in conventional classroom settings [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen examining the descriptive characteristics of the students who received moulage-assisted education (intervention group) and those who received classical wound care education (control group), it was determined that both groups were similar (homogeneous) in terms of gender, educational background, and status of willingly choosing the nursing profession (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The homogeneity of the two groups is of utmost significance for the avoidance of bias and the elimination of confounding factors. The mean age of the participants was 20.09\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96 in the intervention group and 19.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72 in the control group, and a statistically significant difference was found between the groups in terms of mean age (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, the inclusion of the students in the intervention and control groups was based on the branches (Branch A and Branch B) formed by the student affairs office of the faculty. Which branch would be included in the intervention group was determined by drawing lots. Therefore, this outcome is considered random.\u003c/p\u003e\u003cp\u003eThe wound care knowledge and dressing skill scores of the female participants in the intervention group were higher than those of their male counterparts (51.34\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53). When the studies on nursing students in the literature were analysed, the scores of female students for skills were found to be statistically significant compared to male students [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Based on these results, it can be asserted that the manipulative skills of female students in the study were higher than those of male students.\u003c/p\u003e\u003cp\u003eWhen the students' status of choosing willingly the nursing profession was analysed, it was observed that 39.1% of the intervention group and 41.3% of the control group willingly chose the nursing profession (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The status of choosing willingly the nursing profession in Turkey has been an issue that has been discussed in many nursing studies. Students who successfully pass a standardised national exam and get a university entrance score choose a profession according to their scores. This may cause the student to get involved in the profession without knowing it and perhaps without liking it. Since the nursing is a profession that requires devotion and compassion, the correlation between status of choosing willingly the profession and some behaviours related to the profession has been investigated in some studies. There are results indicating in the literature that students who choose the profession willingly have higher patient safety attitudes, professional self-confidence, as well as many professional knowledge and skill evaluations [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This study also revealed that the wound care knowledge and dressing skill scores, the mean scores on the simulation design scale, (Best Design Elements (support, problem-solving, feedback/guided reflection)) were generally higher.\u003c/p\u003e\u003cp\u003eNo statistically significant difference was found in the intergroup comparisons of the wound care knowledge scores of the students (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The results of national and international studies, which examined how different levels of simulation applications affect students' knowledge levels, differ. In their study, Akhu-Zaheya et al., (2013) found no statistically significant difference between the basic life support knowledge scores of students in both groups with low and high-fidelity simulation applications. The study conducted by Levett-Jones et al., (2011), to analyse the effect of medium and high- fidelity simulation applications on the knowledge acquisition level of students reported no statistically significant difference between the knowledge scores of the students in two groups [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe literature also contains the related studies that reported a statistically significant difference between the knowledge levels of the intervention and control groups at different levels of simulation. Garg et al., (2019) found a statistically significant difference between the students' knowledge scores in their study on the implementation of images to one group and moulage to the other group for students to know and diagnose skin lesions. The study by Uzelli and Sarı (2018) reported that the knowledge scores of the students who were subjected to hybrid simulation were significantly higher than those who applied low-fidelity simulation [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFindings of the present study showed that the difference between the pre-test and post-test wound care knowledge scores of the students was statistically significant in intragroup comparisons, and the post-test score was higher for both groups (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This result suggests that both moulage education and classical wound care education contributed to the basic knowledge level of students about wound care and increased their knowledge scores. Likewise, in their study, Sezg\u0026uuml;nsay and Başak (2020) examined the efficacy of moulage in the development of pressure ulcer evaluation skills in nursing students and determined that the post-test scores of the students in the intervention and control groups were higher than the pre-test scores, and the difference between them was statistically significant.\u003c/p\u003e\u003cp\u003eThe wound care knowledge and dressing skill scores of the students in the intervention group were higher than scores of those in the control group and the difference between them was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This result led to the conclusion that \u0026ldquo;moulage education is effective in skill development\u0026rdquo; as a response to the most important question of the study, \u0026ldquo;How does moulage-assisted education affect the wound care skills of students?\u0026rdquo;.\u003c/p\u003e\u003cp\u003eThe basic education provided to both groups on wound care similarly elevated their knowledge levels; however, the students who received moulage-assisted education had more knowledge levels than the students who did not receive moulage-assisted education.\u003c/p\u003e\u003cp\u003eThe total mean score of the students on the \u0026ldquo;Student Satisfaction and Self Confidence in Learning Scale\u0026rdquo; was 4.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 in the intervention group and 4.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.22 in the control group, and when comparing the total mean scores of the intervention and control groups on the \u0026ldquo;Student Satisfaction and Self-Confidence in Learning Scale\u0026rdquo; with their mean scores on the \u0026ldquo;Satisfaction with Current Learning\u0026rdquo; and \u0026ldquo;Self-Confidence in Learning\u0026rdquo; subscales of the scale, it was determined that total and subscale mean scores of the students in the intervention group were statistically significantly higher (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis result showed that the use of moulage in wound care education elevated the level of self-confidence and satisfaction in students. The research questions \u0026ldquo;How does moulage-assisted education affect student satisfaction?\u0026rdquo; and \u0026ldquo;How does moulage-assisted education affect student self-confidence?\u0026rdquo; were answered positively. It is thought that this result was due to the fact that students can easily apply their skills in high-fidelity settings.\u003c/p\u003e\u003cp\u003eWhen the literature was examined, the related studies reported that the mean scores on the Student Satisfaction and Self-Confidence in Learning Scale were significantly higher in the high-fidelity simulation groups compared to the low-level simulation groups [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSimulation methods, which create areas most suitable for the real patient care setting and are increasingly used in nursing education, improve students' communication and critical thinking skills, as well as increasing students' satisfaction with learning and self-confidence [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The evaluation of the satisfaction and self-confidence of nursing students is crucial as indicators of learning effectiveness. Moreover, the satisfaction levels of university students play an important role in maintaining their motivation. The related studies in the literature have reported that the mean scores of nursing students on satisfaction with simulation applications are high. This study also revealed that the students' satisfaction levels in the moulage application group were high, which is compatible with the studies in the literature [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere was a statistically significant and positive correlation between the wound care knowledge and dressing skill scores of the students in the intervention group and their total scores on the Simulation Design scale (best design elements) and their scores on support, problem-solving, and fidelity subscales (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). This result led to the conclusion that \u0026ldquo;The use of moulage positively affects the wound care skills, satisfaction and self-confidence of the students\u0026rdquo; as a response to the main question of the research, \u0026ldquo;How does the use of moulage affect the wound care practices of the students?\u0026rdquo;. It is quite important and useful for nursing education to prepare and implement effective simulations prepared in accordance with the standards and having the necessary simulation design elements and to evaluate their importance according to the student.\u003c/p\u003e\u003cp\u003eConsequently, nursing education has been going through rapid development and change. Learning professional skills is very important in nursing education practices. In this regard, the use of simulation in nursing education creates an environment close to the real clinical environment, allowing knowledge and skills to be learned in a safe learning setting, and it is thought that high-fidelity simulations improve student satisfaction and self-confidence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe nursing students who were currently enrolled in the undergraduate programme at a university were included in the study. Therefore, the results of the study can only be generalised to the students who possess these characteristics. Since the data were collected from the students through face-to-face interview method, the reliability of the data is limited only to the information provided by the interviewees.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study, which was conducted to examine the effect of the use of moulage on the knowledge and skill levels of nursing students in wound care education, revealed that the wound care and dressing skill scores of the students in the intervention group as well as the total mean score of the \u0026ldquo;Student Satisfaction and Self-Confidence in Learning Scale,\u0026rdquo; and subscale mean scores were higher compared to the students in the control group. The comparison of the scores on the Simulation Design Scale and its subscales indicated that the mean scores of the students in the intervention group were higher.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eBased on the results of the study, it is recommended\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTo use moulage technique in wound care and dressing skill education of nursing students,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo incorporate moulage method into simulation to improve self-confidence and satisfaction of nursing students in skills education,\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTo repeat the study with a larger sample size and different student groups.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the nursing students who participated of the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKara H:\u0026nbsp;\u003c/strong\u003edata curation (equal), formal analysis (lead), project administration (equal), writing \u0026ndash; original draft (lead);\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026Ccedil;amlı D\u0026Ccedil;:\u0026nbsp;\u003c/strong\u003edata curation (equal), project administration (equal), writing, review, and editing (lead).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed and approved the final version of the manuscript submitted for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. Informed voluntary consent form was obtained from the participants. The protocol was approved by the Manisa Celal Bayar University, Medical Faculty Health Sciences of the Ethics Committee (Date November 11, 2020; Number: 20,478,486/638).). Additionally, institutional permission was obtained from the institution where the data was collected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAddress for correspondence:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHavva Kara\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Nursing, Manisa Celal Bayar University Number: 8/4, 5526 Street, Uncubozk\u0026ouml;y Neighborhood, Zip code: 45030, Manisa, Tukey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhone:\u003c/strong\u003e+90 507 624 19 79\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE-mail:\u0026nbsp;\u003c/strong\[email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eŞen H. 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BMJ Open. 2019; 9(2): e025306. https://doi.org/10.1136/bmjopen-2018-025306\u003c/li\u003e\n\u003cli\u003eSarı, D., \u0026amp; Erdem, H. The use of high-fidelity simulation in nursing education: A literature review. Journal of Human Sciences. 2017;\u003cem\u003e \u003c/em\u003e14(4): 3690-3707. https://www.j-humansciences.com/ojs/index.php/IJHS/article/view/4882\u003c/li\u003e\n\u003cli\u003eKang, K. A., Kim, S., Kim, S. J., et al. Comparison of knowledge, confidence in skill performance (CSP) and satisfaction in problembased learning (PBL) and simulation with PBL educational modalities in caring for children with bronchiolitis. Nurse Education Today,\u003cem\u003e \u003c/em\u003e2015; \u003cem\u003e35\u003c/em\u003e(2): 315-321. https://www.sciencedirect.com/science/article/pii/S0260691714003293?via%3Dihub\u003c/li\u003e\n\u003cli\u003eLee, M. N., Kang, K. A., Park, S. J., et al. Effects of pre-education combined with a simulation for caring for children with croup on senior nursing students. Nursing \u0026amp; Health Sciences.\u003cem\u003e \u003c/em\u003e2017; 19 (2): 264-272. https://pubmed.ncbi.nlm.nih.gov/28436091/\u003c/li\u003e\n\u003cli\u003eZapko, K. A., Ferranto, M. L. G., Blasiman, R., et al. Evaluating best educational practices, student satisfaction, and self-confidence in simulation: A descriptive study.\u003cem\u003e \u003c/em\u003eNurse Education Today.\u003cem\u003e \u003c/em\u003e2018; 60:\u003cem\u003e \u003c/em\u003e28-34. https://www.sciencedirect.com/science/article/pii/S0260691717302162?via%3Dihub.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"simulation, nursing, education, students, wound","lastPublishedDoi":"10.21203/rs.3.rs-7031096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7031096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe use of moulage is a technique that supports the sensory perception of participants and the fidelity of the simulation scenario in nursing education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to determine the effect of moulage use on developing wound care skills in nursing students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDESIGN AND SETTING:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized-controlled study was conducted at the Faculty of Health Sciences at Manisa Celal Bayar University, Manisa, Turkey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e92 students who met the inclusion criteria participated in the study conducted between October 2021 and January 2022. 'Wound Care Information Form', 'Wound Care and Dressing Skill Form', 'Student Satisfaction and Self-Confidence in Learning Scale' and 'Simulation Design Scale' were used in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the research findings, it was determined that the difference between the wound care knowledge score pre-test and post-test scores was statistically significant and the post-test scores were higher. In the study, it was found that the wound care and dressing skill scores of the students in the intervention group were higher than the scores of the students in the control group and the difference was statistically significant (p \u0026lt; 0.05). It was determined that the mean scores of both scales and subscale scores of the students in the intervention group used in the study were higher and the difference was statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was found that the moulage application made a positive contribution to the students' wound care skill scores, students' self-confidence and satisfaction scores, and the simulation design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Does Use of Moulage Affect the Wound Care Skills of Nursing Students?: A Randomised Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 11:12:01","doi":"10.21203/rs.3.rs-7031096/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"75fc1f79-5217-4c18-bf3a-8270c4ef4e95","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-06T14:56:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-17 11:12:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7031096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7031096","identity":"rs-7031096","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}