This study was designed as a single-group pretest–posttest quasi-experimental intervention. It was conducted between June and September 2025 at the pediatric clinics of Ankara Bilkent City Hospital, Türkiye. Eligible participants were nurses actively working in pediatric wards for at least six months who provided written informed consent. Nurses who declined participation or did not complete the data collection procedures were excluded.

A total of 475 nurses were employed at Ankara Bilkent City Hospital, all of whom were invited to participate in the study. A formal sample size calculation was not performed; instead, the study sought to recruit at least 80% of the nursing workforce. Of these, 436 nurses agreed to participate (91.8%). Following the exclusion of incomplete responses and extreme values, data from 399 nurses were retained for the final analysis. Ethical approval was obtained from the Ankara City Hospital Clinical Research Ethics Committee (Approval No: TABED-1-25-1297).

Data were analysed using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA). Missing values and outliers were screened using the interquartile range method. The Kolmogorov–Smirnov test indicated non-normal distribution of continuous variables; therefore, nonparametric tests were applied. •

Wilcoxon signed-rank test was used to compare pretest and posttest scores.

Of the 475 nurses invited to the program, 436 agreed to participate (91.8%). After excluding incomplete and outlier data, analyses were performed on 399 participants. The majority were female (84.7%, n = 338), and the median age was 28 years (range: 23–53). Most participants held a bachelor's degree (87.5%, n = 349) and nearly half had 5–8 years of professional experience (47.4%, n = 189).

Regarding prior exposure to extravasation, 8.3% (n = 33) reported never encountering a case, 77.7% (n = 310) rarely, and 14% (n = 56) frequently. Most participants (77.9%, n = 311) had never received any training on extravasation, while 88.5% (n = 353) expressed a need for further education.

Knowledge test scores significantly increased following training (p < 0.001), with a small effect size (r = –0.26). Skill test scores also improved significantly (p < 0.001), with a large effect size (r = –0.84), indicating substantial gains in clinical performance. General characteristics of the test results and the comparison of the mean scores are summarized in Tables 1, 2.

The results of the subgroup analyses are presented in Table 3. •

Gender: No significant differences were observed in pretest scores between male and female nurses. Posttest improvements were higher among female participants, but the difference was not statistically significant (p > 0.05).

This study evaluated the impact of scenario-supported extravasation and infiltration management training on pediatric nurses' knowledge and skills. Findings showed a small effect on knowledge (r = –0.26) and a large effect on skills (r = –0.84), indicating that the program was particularly effective in improving practical competencies. Previous research supports these results, showing that simulation-based education significantly enhances clinical reasoning and performance (12, 14). Our results highlight that experiential, scenario-based approaches may facilitate the transfer of knowledge to clinical practice more efficiently than traditional didactic methods, especially in the development of procedural and decision-making skills in line with the literature. Also, our study reinforces existing evidence by showing that structured, scenario-driven training yields greater improvements in skill-based outcomes compared to theoretical knowledge gains.

Although female nurses achieved greater improvements in both knowledge and skill scores than male nurses, these differences were not statistically significant. This is consistent with studies reporting that simulation-based learning benefits learners regardless of gender (23). Accordingly, the scenario-based low-fidelity simulation training appears to be equally effective for nurses of both genders.

Professional experience was found to influence knowledge improvement, particularly among nurses with 5–8 years of work experience. According to Benner's “From Novice to Expert” model, these nurses are typically in the competent or proficient stages of practice, where structured training can accelerate professional development (24, 25). In contrast, novice nurses may require additional foundational support, while more experienced nurses may approach a performance ceiling. These findings suggest that mid-career nurses are especially positioned to benefit from scenario-based education and that considering professional stage when forming training groups may optimise educational outcomes.

A notable finding was that 78% of participants had never received previous extravasation training, and 88% expressed a strong need for education, indicating a substantial gap in routine clinical training practices. Moreover, nurses with prior training demonstrated greater skill improvements, even though knowledge improvements did not differ. This suggests that repeated and practice-based training plays a critical role in reinforcing competencies. Consistent with earlier studies, repeated exposure to simulation has been shown to promote mastery and self-efficacy (13, 15). Given the potential severity of extravasation events in pediatric care, this lack of structured education represents a preventable patient-safety risk. Therefore, these findings emphasize the necessity of embedding recurring scenario-based modules into continuous professional development instead of relying on one-time programs.

Similar positive outcomes have been reported in oncology nursing. For example, educational interventions on safe chemotherapy administration improved knowledge and skills among nurses (26). High-fidelity simulation has also been shown to significantly enhance nursing students' competence in managing chemotherapy extravasation (27). In neonatal care, guideline implementation studies demonstrated improvements in the prevention and management of extravasation injuries (18). Our study contributes to this evidence by demonstrating that a low-cost, scenario-supported training model can achieve meaningful skill gains among practicing pediatric nurses. While highfidelity simulation remains valuable, its resource requirements may limit widespread adoption; therefore, our findings indicate that simplified scenario-based approaches offer a scalable and accessible alternative, particularly for institutions with constrained resources. Moreover, the clinical applicability of such models suggests that structured and recurring scenario-based programs should be incorporated into pediatric nursing curricula, with emphasis on practical skill development and cost-effective implementation strategies.

Strengths of this study include the large sample size (n = 399), the structured design using both pre- and post-tests, and the combined evaluation of knowledge and skills. However, several limitations should be acknowledged. First, the study was conducted at a single center with a predominantly young and bachelor-level nurse population, limiting generalizability. Second, the effects were assessed only in the short term; long-term knowledge and skill retention remain unknown. Third, no randomized controlled design was used, which reduces the strength of causal inference. As expected in performance-based assessments, the OSPE demonstrated moderate internal consistency. OSPE checklists typically include diverse procedural steps that do not necessarily correlate strongly with one another, which can lower alpha coefficients without compromising the validity of the assessment (21). Despite this, the structured checklist and standardized scoring procedure enhance objectivity and reduce examiner bias, supporting the practical reliability of the tool. Finally, simulation in this program was low-fidelity and primarily applied as an assessment method through case-based scenarios and OSPE, rather than as immersive high-fidelity training. This may explain the relatively modest improvement in knowledge scores.