Improving subcutaneous injection safety among nurses: a randomized controlled trial of video-based and face-to-face training

Abstract

Background

Injection safety is vital in nursing practice. Registered nurses may lack adequate skills due to limited clinical experience. The aim of this study is to compare the effects of video-based and face-to-face training methods on the subcutaneous injection safety knowledge and practical skills of registered nurses.

Methods

A randomized controlled design was used to compare video-based and face-to-face training in improving injection safety among 82 registered nurses. Data were collected using researcher-developed forms assessing knowledge, skills, satisfaction, and demographics. CONSORT checklist followed in this study. No adverse events were observed during the study.

Results

Training delivered both online and in face-to-face improved knowledge and skills. However, face-to-face training resulted in significantly higher knowledge scores (91.2 ± 8.61) for subcutaneous injection than online training (82.24 ± 11.39) indicating a mean difference of 8.96 points (mean difference = 8.96; 95% CI: 4.58–13.34; Cohen’s d = 0.89; p < 0.001), with an achieved power of 0.89.

Conclusions

Both face-to-face and video-based education effectively improved knowledge and skills, highlighting the value of ongoing training in ensuring patient safety and subcutenous heparin injection practice.

Trial registration

This trial was prospectively registered at ClinicalTrials.gov (NCT05469035) on July 21, 2022, prior to the enrollment of the first participant. Current controlled trials clinical trials ID: NCT05469035 (Date:21.07.2022).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-04281-5.

Background

Subcutaneous injections represent one of the most frequently performed clinical procedures in nursing practice, yet they continue to pose significant safety challenges. Recent studies demonstrate that improper technique leads to complications in 35–50% of cases, with pain, bruising, and hematoma formation being the most commonly reported adverse outcomes [1]. These complications not only cause patient discomfort but may also compromise treatment efficacy, particularly for high-risk medications like low-molecular-weight heparin (LMWH), which is an anticoagulant that reduces the blood’s ability to clot and is usually administered by subcutaneous injection [2, 3]. The prevalence of these issues is especially concerning among registered nurses, with clinical audits revealing that nearly 40% lack confidence in performing subcutaneous injections correctly during their first year of practice [4–6]. This confidence gap persists despite subcutaneous injections being a fundamental nursing skill, suggesting potential deficiencies in current training approaches.

The complexity of proper subcutaneous injection technique is often underestimated in nursing education. Optimal administration requires precise control of multiple variables including needle insertion angle, injection speed, and site selection, each of which significantly impacts patient outcomes [7–11]. Research indicates that even minor deviations from recommended protocols, such as increasing injection speed by just 10 seconds or altering the insertion angle by 5 degrees, can nearly double the risk of complications [12–18]. These findings highlight the critical need for training methods that not only convey theoretical knowledge but also develop the psychomotor skills necessary for consistent, safe practice [19, 20]. Current educational approaches vary widely between institutions, with no consensus on optimal training duration or methodology, creating inconsistencies in nurse preparedness [21–24].

The rapid integration of digital learning tools into nursing education has introduced new opportunities and challenges for teaching clinical skills. While video-based instruction offers advantages in accessibility and standardization, questions remain about its effectiveness for developing the tactile precision required for subcutaneous injections [23, 25]. Comparative studies have produced mixed results, with some showing equivalent outcomes between digital and traditional methods, while others demonstrate superior skill retention with face-to-face training [26–28]. This discrepancy may stem from differences in how various programs implement digital tools, suggesting that the instructional design of video-based training may be as important as the medium itself. Drawing on principles of experiential learning and motor skill development, face-to-face instruction enables active, hands-on engagement that promotes immediate feedback, real-time correction, and physical reinforcement. Such interactive learning environments support the integration of theoretical knowledge with practical performance, which is often more difficult to achieve through video-based training alone [29, 30].

The aim of this study was to compare the effects of video-based and face-to-face training methods on registered nurses’ knowledge and practical skills regarding safety subcutaneous injection.

Methods

Study design

This study was designed as a randomized controlled trial with a two-arm parallel-group structure comparing video-based and face-to-face training methods. Participants were randomly allocated in a 1:1 ratio. Because the intervention required active participation, blinding of participants and trainers was not possible. However, the two independent evaluators who conducted the knowledge and skill assessments were blinded to group allocation during both the pre-test and post-test evaluations. A pre-test/post-test design was used. This trial was conducted and reported in accordance with CONSORT guidelines and was prospectively registered at ClinicalTrials.gov (NCT05469035) on July 21, 2022, prior to the enrollment of the first participant on July 25, 2022.

Outcomes

Primary outcome: The primary outcome of this study was the change in nurses’ knowledge of subcutaneous injection safety.

Secondary outcomes:

1. Improvement in nurses’ practical subcutaneous injection skills, as assessed through observed simulation or checklist-based evaluation.

2. Nurses satisfaction with the training method, measured via a standardised survey.

Study participants and setting

The study group included registered nurses with 1–4 years of clinical experience working in internal medicine, surgery, and intensive care units at a state hospital in Istanbul, Türkiye, where subcutaneous heparin is frequently administered. The research was conducted between July and December 2022. A total of 98 nurses working in these units were invited to participate using a consecutive sampling approach, and those who met the inclusion criteria and agreed to participate were enrolled. Nurses were randomly assigned to the video-based and face-to-face training groups (n = 45 each) according to the name list using the http://www.random.org program. The randomization list was prepared by a researcher who was not involved in either the training sessions or the data collection procedures. To ensure allocation concealment, group assignments were placed in sequentially numbered envelopes, which were opened only after each participant was enrolled. Knowledge and skill assessments were conducted by two independent researchers who did not take part in the training implementation. These evaluators were blinded to the group assignments during both the pre-training and post-training assessments to minimize assessment bias and enhance internal validity.

During the study, some participants did not fully attend the training or data collection sessions (3 from the video-based group and 5 from the face-to-face group), resulting in final sample sizes of video-based group 40 and face-to-face group 42 nurses, respectively. Inclusion criteria included voluntary participation, prior experience with LMWH injection, and full attendance in training sessions. A post hoc power analysis with G*Power 3.1 showed that the achieved power was 89.6% (effect size: 0.5; α = 0.05).

The intervention

The training included key elements of subcutaneous injection, such as preparation of materials and medication, patient readiness, site preparation, injection technique, and post-injection care. In the video-based group, a 6-minute-36-second educational video created by the lead researcher visually and audibly demonstrated correct procedures using a model. The face-to-face training, conducted by the researchers in a clinical skills lab with a model, followed the same structure and lasted 8–10 minutes. Both groups practised in a controlled setting equipped only with the required materials and models, allowing independent skill assessments without participant interaction or influence.

Face-to-Face Training Group (n = 42)

Training was organized in five sessions (8–9 participants each). First, participants completed data collection forms and performed a subcutaneous injection on a practice model, evaluated using the skills checklist. The training content (indications, landmarks, needle selection, injection angle, aspiration, rotation, complication prevention) was delivered via an instructor-led PowerPoint presentation followed by live demonstration. One hour later, participants completed the post-training knowledge test and the same model-based skill assessment.

Video-Based Training Group (n = 40)

The video-based training group followed the same pre-training procedures as the face-to-face group, including completion of data collection forms and baseline model-based injection performance evaluated using the skills checklist. Instead of an in-person lecture and live demonstration, participants received a 6-minute-36-second evidence-based instructional video that covered the same training content. Participants were required to watch the video within one day, and viewing was confirmed by participant declaration. Following video viewing, the same post-training knowledge test and skills assessment were administered as in the face-to-face group.

Data collection

The data of the study were collected using the Individual Characteristics Form, the Subcutaneous Heparin Knowledge Assessment Form, the Subcutaneous Heparin Skill Assessment Form, and the Satisfaction Assessment Form (Supplementary File 1). These data collection instruments were developed by the researchers specifically for this study and had not been used previously.

To ensure content validity, the draft forms were reviewed by an expert panel consisting of three nursing academician and two experienced clinical nursing professionals who evaluated each item for relevance, clarity, and appropriateness to clinical practice. Necessary revisions were made in line with their recommendations. Face validity of the instruments was assessed through a pilot test with five nurses outside the main study sample, focusing on clarity, feasibility, and applicability; no pilot data were included in the analyses. To minimize measurement bias, two trained researchers independently evaluated skill performance using the standardized checklist. Additionally, two trained researchers independently evaluated the skill performance using the same standardized checklist to reduce measurement bias. Both assessors were briefed on scoring criteria before data collection to ensure consistency. Although formal reliability statistics (e.g., inter-rater coefficients) were not calculated, using a shared scoring protocol supported consistency in evaluation.

Data collection tools

Individual characteristics form

This researcher-developed form collected demographic and professional data, such as age, gender, education, work experience, unit, role, frequency of subcutaneous heparin use, prior training, and related complications.

Subcutaneous heparin knowledge assessment form

This 15-item form, developed from the literature, evaluates nurses’ knowledge of subcutaneous heparin administration. Expert-reviewed and piloted with 10 student nurses, it was finalized and administered pretraining and posttraining via Microsoft Forms using True, False or I don’t know options. In this study, the Cronbach alpha value of the form was found to be 0.83.

Subcutaneous injection skill assessment form

The 10-item form was developed based on literature to assess nurses’ practical skills in subcutaneous heparin administration. After expert review and pilot testing with 10 student nurses, the form was finalized. Both groups were evaluated pretraining and posttraining using a realistic training model. Skills were rated as Performed, Partially Performed, or Not Performed. In this study, the Cronbach alpha value of the form was found to be 0.89.

Satisfaction assessment form

Training satisfaction was assessed post-intervention using a 10-cm Visual Analog Scale (VAS), ranging from 0 (not pleasant at all) to 10 (very satisfied). Participants marked their satisfaction level on the line.

Statistical analysis

The analysis was conducted using a per-protocol approach. As all randomized participants completed the study and provided complete outcome data, the risk of attrition bias was minimal. The data obtained from the study were evaluated in IBM SPSS Statistics 21. Descriptive statistical analysis was performed and the data were presented using frequencies (n) and percentages (%). The normality of the data distribution was assessed using the Kolmogorov–Smirnov test, and skewness–kurtosis values were examined. As all continuous variables met parametric test assumptions, Independent Samples t-tests were used for between-group comparisons of scale scores, and Paired Samples t-tests were used for repeated measurements within groups. Chi-squared tests were employed to compare descriptive characteristics. For all analyses, 95% confidence intervals and Cohen’s d effect sizes were reported in addition to p-values, and the significance level was set at p < 0.05.

Ethical considerations

Ethical approval for this study was obtained from the Non-Interventional Clinical Research Ethics Committee of Istanbul Medipol University (E-10840098-772.02–1639/205). Also, the patients participating in the study were informed about the study and their verbal and written informed consents were obtained.

Results

This study analyzed data from 82 nurses (video-based training group, n = 40; face-to-face training group, n = 42). All randomized participants met the inclusion criteria, completed the data collection forms, and were included in the final analysis, confirming a per-protocol approach. No adverse events were observed. The study flowchart was prepared in accordance with the CONSORT guidelines (Fig. 1).

Fig. 1.

Allocation of subjects according to the consort 2010 flow diagram

Participant characteristics and study outcomes

Table 1 presents the baseline individual and professional characteristics of the nurses, categorised by study group. The majority of participants in the face-to-face training group (n = 42) were female (85.7%), compared to 72.5% in the video-based training group (n = 40). In both groups, the majority of nurses held a bachelor’s degree (69.0% in the face-to-face group and 77.5% in the video-based group). In terms of professional experience, a higher proportion of nurses in the video-based training group had 1–2 years of experience, whereas a higher proportion of nurses in the face-to-face training group had 2–4 years of experience. The frequency of subcutaneous injection administration was similar between the two groups, with the majority of participants reporting that they performed injections 1–10 times per day. In both groups, the majority of nurses received subcutaneous injection training during their undergraduate nursing education. A minority of participants in both groups reported experiencing complications during or after subcutaneous injections (Table 1).

Table 1.

Baseline characteristics of nurses according to study groups (n=82)

	Face-to-face training n = 42		Video-based training n = 40		Total n = 82
	n	%	n	%	n	%
Gender
Female	36	85.7	29	72.5	65	79.3
Male	6	14.3	11	27.5	17	20.7
Educational status
Highschool	3	7.1	5	12.5	8	9.8
Associate degree	4	9.5	0	0.0	4	4.9
Bachelor’s degree	29	69.0	31	77.5	60	73.2
Master’s degree	6	14.3	3	7.5	9	11.0
Doktorate (PhD)	0	0.0	1	2.5	1	1.2
Years of working as a nurse
1 year	9	21.4	30	75.0	39	47.6
2 years	19	45.2	8	20.0	27	32.9
3 years	3	7.1	0	0.0	3	3.7
4 years	11	26.2	2	5.0	13	15.9
Frequency of subcutaneous injection application
1–5 times in a day	20	47.6	23	57.5	43	52.4
6–10 times in a day	22	52.4	17	42.5	39	47.6
Where did you get the training?
Bachelor’s degree	31	73.8	30	75.0	61	74.4
In-service training	8	19.0	6	15.0	14	17.1
Scientific journals or other sources	0	0.0	3	7.5	3	3.7
Internet	3	7.1	1	2.5	4	4.9
Complications in-while application
Yes	4	9.5	13	32.5	17	20.7
No	38	90.5	27	67.5	65	79.3
Complications after application
Yes	8	19.0	9	22.5	17	20.7
No	34	81.0	31	77.5	65	79.3

n: Number of the participant, % :percentage

No statistically significant differences were found between the face-to-face and video-based training groups in terms of their baseline demographic and professional characteristics.

Posttraining knowledge and skill outcomes are presented in Table 2. No statistically significant associations were found between baseline demographic or professional characteristics and posttraining knowledge or skill scores (p > 0.05). (Table 2).

Table 2.

Comparison of post-test total knowledge and skill scores according to nurses’ characteristics (n=82)

Characteristics		Post-Test Total Knowledge		Post-Test Skill
		Mean ± SS	p	Mean ± SS	p
Gender	Female (n = 65)	87.8 ± 10.44	0.12	87.38 ± 11.99	0.647
	Male (n = 17)	83.14 ± 12.44		85.88 ± 12.02
Educational status	Highschool (n = 8)	84.27 ± 7.96	0.314	77.5 ± 12.81	0.096
	Associate degree (n = 4)	94.55 ± 6.84		83.75 ± 7.5
	Bachelor’s degree (n = 60)	86.67 ± 11.37		87.83 ± 12.01
	Master’s degree (n = 9)	87.6 ± 12.17		90.55 ± 8.81
	Doctorate (PhD) (n = 1)	79.2		100
Years of working as a nurse	1 year (n = 39)	83.89 ± 11.82	0.069	84.87 ± 13.35	0.298
	2 years (n = 27)	89.23 ± 8.19		88.14 ± 10.57
	3 years (n = 3)	97.46 ± 4.38		96.66 ± 5.77
	4 years (n = 13)	88.21 ± 12.25		89.07 ± 11.93
Frequency of subcutaneous injection application	1–5 times in a day (n = 43)	87.87 ± 10.77	−0.123	87.67 ± 9.9	−0.154
	6–10 times in a day (n = 39)	85.69 ± 11.21		86.41 ± 13.95
Complications in-while application	Yes (n = 17)	86.36 ± 10.27	−0.329	89.11 ± 13.37	−1.223
	No (n = 65)	86.96 ± 11.22		86.53 ± 11.58
Complications after application	Yes (n = 17)	88.03 ± 10.96	−0.528	90 ± 12.5	−1.433
	No (n = 65)	86.52 ± 11.03		86.30 ± 11.76
Where did you get the training?	Bachelor’s degree (n = 61)	87.56 ± 10.26	0.175	86.63 ± 12.57	0.837
	In-service training (n = 14)	84.12 ± 14.29		87.14 ± 12.04
	Scientific journals or other sources (n = 3)	77.0 ± 7.62		93.33 ± 2.88
	Internet (n = 4)	92.65 ± 5.80		88.75 ± 2.5

Pearson Chi-Square Test n: Number of the participant, SS: Standard Deviation, p < 0.05

Pretraining and posttraining in knowledge scores

As presented in Table 2, within-group analyses demonstrated significant improvements in knowledge scores following the intervention in both the face-to-face (control) and video-based (experimental) training groups (p < 0.001). However, the face-to-face group exhibited significantly higher mean post-test knowledge scores compared to the video-based group (p < 0.001). Effect size estimates and 95% confidence intervals are reported in the text below Table 3.

Table 3.

Comparison of the groups’ subcutaneous injection education knowledge and skill mean scores (n =82)

Groups Measurements		Video-based training (n = 40) mean ± SD (Min-Max)	Face-to-face training (n = 42) mean ± SD (Min-Max)	F** p
Knowledge	Pre-test	64.13 ± 12.4 5–65	69.14 ± 14.52 5–60	2.731 0.098
	Post-test	82.24 ± 11.39 50–100	91.2 ± 8.61 65–100	1.271 < 0.001
t* p		−6.32 < 0.001	−8.14 < 0.001
Skill	Ön test	32.5 ± 15.1 5–65	31.42 ± 12.65 5–60	2.8 0.098
	Son Test	85.12 ± 12.93 50–100	88.92 ± 10.73 65–100	1.28 0.261
t* p		−18.15 < 0.001	−24.92 < 0.001
Satisfaction		8.77 ± 1.44	9 ± 1.39	0.408 0.47

*: Paired Sample t-Test, **: Independent Sample t-Test, n: Number of the participant, SD: Standart Deviation

Mean difference = 8.96; 95% CI: 4.58–13.34; Cohen’s d = 0.89; p < 0.001

Pretraining and posttraining practical skill scores

Both groups showed statistically significant improvements in practical skill scores post-intervention (p < 0.001). Although the face-to-face group had higher mean post-training skill scores, this difference was not statistically significant compared to the video-based group (p > 0.05) (Table 3). Corresponding effect size estimates and 95% confidence intervals are reported below Table 3.

Sub-dimension analysis of subcutaneous injection skill assessment

Table 4 illustrates that both groups demonstrated significant increases in sub-dimension scores

Table 4.

Comparison of pre-test and post-test average scores according to sub-dimension of nurses’ subcutaneous injection skill assessment form (SISAF) (n=82)

Sub-dimensions of SISAF	Video-based training (n = 40)		P	Face-to-face training (n = 42)		p
	Pre-Test Mean ± SD	Post-Test Mean ± SD		Pre-Test Mean ± SD	Post-Test Mean ± SD
Abdominal administration	4.87 ± 4.86	9.25 ±2.41	< 0.001	5.23 ± 4.67	10	< 0.001
Waiting for alcohol to dry	1.87 ± 2.7	8.75 ± 3.15	< 0.001	2.97 ± 3.99	8.69 ± 2.48	< 0.001
Raising skin	6.6 ± 3.8	9.7 ± 1.58	< 0.001	7.02 ± 3.83	9.28 ± 1.77	0.05
Not aspirating	2.25 ± 3.74	10	< 0.001	4.64 ± 4.73	8.09 ± 3.11	0.004
Not moving the needle once inside the tissue	3.12 ± 4.18	8.87 ± 2.65	< 0.001	4.76 ± 4.27	9.52 ± 1.48	< 0.001
Duration (15–30 sec)	4.5 ± 4.5	9.25 ± 2.66	< 0.001	0.47 ± 1.48	9.64 ± 1.7	< 0.001
Using the airlock technique	2.62 ± 3.92	7 ± 4.35	< 0.001	1.30 ± 2.71	7.97 ± 2.93	< 0.001
Using dry cotton	3.75 ± 4.34	8.62 ± 2.77	< 0.001	2.14 ± 3.84	9.52 ± 2.15	< 0.001
Using appropriate pressure	2.5 ± 3.58	7.62 ± 3.75	< 0.001	1.66 ± 3.05	8.8 ± 2.66	< 0.001
Applying other interventions	0.37 ± 1.33	6.12 ± 4.45	< 0.001	1.19 ± 7.38	2.8 ± 3.86	< 0.001

Paired Sample t-Test, n: Number of the participant, SD: Standart Deviation

related to safe injection techniques on the Subcutaneous Injection Skill Assessment Form (SISAF) following training (p < 0.05).

Discussion

This study’s findings showed that training—whether face-to-face or video-based—significantly improved both knowledge and skills in administering subcutaneous heparin injections. Notably, face-to-face training proved more effective in enhancing knowledge than video-based education (p < 0.001), which aligns with literature underscoring the advantages of face-to-face instruction for skill acquisition in healthcare settings [22, 23]. While video-based education is increasingly popular, particularly following the COVID-19 pandemic, face-to-face training remains crucial, especially in procedures involving psychomotor skills like injection techniques. This outcome emphasizes the importance of incorporating practical, hands-on training into nursing education, especially for registered nurses who may lack clinical experience [20, 24].

Our results indicated statistically significant improvements in nurses’ injection technique, especially regarding site selection, injection speed, and post-injection practices. Studies have shown that selecting the abdominal area for LMWH injections reduces the risk of complications compared to other sites, such as the arms or thighs, because of its thicker adipose layer and lower mobility [5, 14, 17, 31]. Additionally, injections in the abdomen are less visible, which can have a positive impact on the patient’s body image. Despite these advantages, our study found that nurses often selected alternative sites due to limited training in abdominal injections specifically for LMWH, underscoring the need for clearer guidance and training in preferred injection sites for different medications.

Another key factor discussed in the literature is whether aspiration should be performed during subcutaneous injections. Aspiration, traditionally used to ensure the needle has not entered a blood vessel, is unnecessary in subcutaneous tissue, where the likelihood of hitting a blood vessel is low [32]. Aspiration not only prolongs the injection process but also increases the risk of tissue damage and local complications. In our study, many nurses initially practiced aspiration during subcutaneous injections. However, following training, there was a noticeable reduction in this practice, thereby reducing the risk of unnecessary trauma and associated complications [4, 10, 14, 33].

Our findings underscore the critical importance of comprehensive training in safe injection techniques for subcutaneous heparin injection. While online and video-based education methods are effective for knowledge dissemination, face-to-face training offers unparalleled advantages for developing psychomotor skills necessary for safe and effective LMWH administration. Psychomotor skills are behaviors that arise from the automatic and coordinated interaction between sensory organs, muscles, and the mind. These skills develop through a complex process involving both cognitive and affective domains [34]. The observed advantages of face-to-face learning in this study may be attributed to specific pedagogical characteristics. Direct and immediate feedback from instructors, guided hands-on practice, and tactile engagement likely enhanced understanding, reinforced learning, and strengthened skill retention, thereby supporting effective clinical performance. Consequently, we recommend a hybrid educational approach that combines both face-to-face and online training to leverage the strengths of each method [20, 25, 31–33, 35–37]. Our findings are consistent with recent systematic review evidence, which reports that simulation-enhanced and face-to-face programmes improve performance and may reduce overall catheter failure, despite heterogeneity across trials [38]. These results strengthen the rationale for structured simulation or in-person coaching with standardized checklists. Incorporating simulation-based training may also be valuable, as it provides a safe environment for nurses to practice and refine their techniques without compromising patient safety [36, 39]. Building on this approach, Erbaş et al. (2025) demonstrated that immersive virtual reality can heighten the sense of presence with only minimal cybersickness, suggesting that integrating VR simulation alongside video-based and face-to-face training could further enhance engagement and psychomotor learning in injection training [40].

Limitations

The limitations of this study include the relatively young age and limited professional experience (maximum of four years) of the nurses, which may affect the generalisability of the findings. In addition, conducting the study in a single hospital setting may limit its external validity. Although the training sessions for the two groups were conducted at different times to minimise interaction, the shared workplace environment may have enabled the exchange of informal information.

This study employed a per-protocol analysis. A small number of participants (n = 8) did not complete the study due to practical constraints, such as illness or work-related scheduling issues. All participants included in the final analysis provided complete outcome data; therefore, the potential impact of attrition bias is considered limited. Nevertheless, this limitation should be taken into account when interpreting the results.

Conclusion

Although individual patient characteristics and medication properties remain beyond nurses’ control, the adoption of proper injection techniques is essential in minimizing complications associated with subcutaneous heparin administration. This study demonstrates that both face-to-face and online training methods significantly enhance nurses’ knowledge and competencies, contributing to improved patient safety. By applying evidence-based practices and emphasizing safe injection procedures, healthcare institutions can reduce adverse events, increase patient comfort, and elevate the overall quality of care. While these findings are promising, their generalizability to broader healthcare settings with different workforce demographics requires further confirmation. Future research must now focus on evaluating the long-term retention of acquired knowledge and, crucially, its transfer and sustainability in bedside performance over time. Furthermore, exploring the efficacy of immersive learning tools, such as virtual reality simulations, in reinforcing and assessing lasting psychomotor competencies could provide a robust foundation for the next generation of nursing education.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Rumeysa DEMIR: Supervision, Software, Data curation, Resources, Methodology, Conceptualization, Visualization, Writing – original draft, Writing –review & editing. Demet INANGIL: Writing – review & editing, Supervision, Conceptualization, Methodology, Resources, Visualization, Software, Data curation, Ilayda TURKOGLU: Writing – review & editing, Writing – original draft, Visualization, Supervision, Software, Resources, Methodology, Data curation, Conceptualization. Merdiye SENDİR: Writing – review & editing, Writing – original draft, Visualization, Supervision, Software, Resources, Methodology, Data curation, Conceptualization.

Funding

The authors has no receipt of the nancial support for the research, authorship, and/or publication of this article.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Non-Interventional Clinical Research Ethics Committee of Istanbul Medipol University (E-10840098-772.02–1639/205). Also, the patients participating in the study were informed about the study and their verbal and written informed consents were obtained. Verbal and written informed consent was provided by all the nurses who participated in the study. Each stage of the study was carried out on a voluntary basis. The study was conducted in accordance with the Declaration of Helsinki. Permission was obtained from the developer of the subcutaneous insulin administration form. Before starting the study, ethical principles were taken into consideration according to the clinical trial number (Date:21.07.2022/NCT05469035).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.