Game-based learning in undergraduate nursing education: A systematic review of mixed-method studies

Real-world and game-based learning to enhance decision-making

BACKGROUND

The evolving healthcare landscape necessitates highly qualified nurses equipped with a myriad of soft skills, including decision-making. Traditional teaching models have led to innovative, active methods that prioritise student participation and enhance crucial soft skill development, such as decision- making. Considering the recognised importance of improving clinical decision-making skills and the need for innovative training, a literature gap is present in assessing the effect of real world and game-based learning on decision-making abilities.

OBJECTIVES

This study aimed to investigate the effect of real-world and game-based learning, specifically using case-based learning and escape room, on decision-making competence in postgraduate nursing students in academic and clinical settings.

DESIGN

A descriptive, cross-sectional, quantitative intervention study was conducted, combining case-based learning and escape room methods sequentially.

SETTINGS

The study was conducted among postgraduate nursing students at the University of Navarra in Spain.

PARTICIPANTS

Sixty-six postgraduate nursing students, mostly women, participated in the study.

METHODS

The study integrated case-based learning and escape room sequentially. Data were collected through an ad hoc online questionnaire, recorded escape times from the escape room, and academic scores.

RESULTS

The study enrolled 66 participants with an average professional experience of 4.2 years. Academic results showed high scores in case resolution (average: 8.34) and knowledge tests (average: 9.21). Out of 11 groups, 81.8 % successfully escaped the escape room within 30 min, with positive questionnaire responses indicating enthusiasm, enjoyment and perceived effectiveness of the activities.

CONCLUSIONS

Real-world and game-based learning significantly enhanced decision-making competence in postgraduate nursing students across academic and clinical settings, demonstrating the importance of diverse teaching methods. Further research, including comparative studies and longitudinal analyses, is needed to evaluate the educational benefits of integrating case-based learning and escape room methods in nurse education and to refine assessment tools while monitoring long-term student progress.

Let the Ultrasound Games Begin: Developing Knowledge and Clinical Skills With Gamification

BACKGROUND

Point of Care Ultrasonography (POCUS) is customary practice in the clinical setting. Formal training ensures competent skills using POCUS but is lacking. Preparing nurse practitioners in POCUS with gamification is an innovative educational tool.

METHOD

The Attention, Relevance, Confidence, and Satisfaction (ARCS) model was used to implement POCUS. Learners participated in a bracket-style elimination tournament.

RESULTS

Learners (N = 109) in the adult-gerontology acute care nurse practitioner track participated. Eighty-eight Bachelor of Science in Nursing (BSN) to Master of Science in Nursing and 21 BSN to Doctor of Nursing Practice learners. Extremely satisfied with the experience were 72.36%, 67.11% were somewhat comfortable, 10.53% were extremely comfortable, and 11.84% were somewhat uncomfortable using POCUS.

CONCLUSION

Gamification for POCUS training is a practical tool to develop knowledge and comfort using ultrasound. Adult learners retain information in various modalities and gamification offers them a multimodal learning opportunity that increases competency. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Comparative Effectiveness of Developed Serious Game Versus Standardized Patients' Simulation in Nursing Education

Background: Serious games provide a realistic environment in nursing education, a stimulating and experiential learning environment for developing skills necessary for learning, recognizing, analyzing, selecting, and applying information. Methods: This study aims to determine the impact of serious games and standard patient practices developed for nursing education on students' knowledge levels, satisfaction, self-confidence, critical thinking, and problem-solving skills. A serious game was designed using the educational principles of the diabetes course and developed using the 3D interactive content creation platform UNITY. One group played the game online, whereas another had a face-to-face experience. Both groups completed forms before, after, and 4 weeks later via Google Forms. Results: Quantitative analysis showed significant improvements in knowledge and increases in student satisfaction and confidence in learning in both the serious game and standardized patient groups. The groups had no significant differences in problem-solving and critical-thinking abilities (P > 0.005). Conclusion: Developing advanced clinical proficiencies in nursing students requires an engaging and reliable educational environment. Using serious games and standardized patient simulations in nursing instruction highlights the need for diverse digital teaching tools. Therefore, it is essential to support the professional development of nursing educators in these innovative modalities.

Application effect of BOPPPS teaching model on fundamentals of nursing education: a meta-analysis of randomized controlled studies

Background

BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) is a student-centered, closed-loop teaching model that emphasizes real-time communication and feedback.

Objectives

The purpose of this study was to review and evaluate the effect of BOPPPS teaching model in "Fundamentals of Nursing" teaching.

Methods

We conducted a meta-analysis of randomized controlled trials (RCTs) based on the BOPPPS teaching model in "Fundamentals of Nursing" teaching. To review domestic and foreign databases for the period 2010 to September 2023. Finally, 13 RCTs were included and the teaching outcomes were measured and analyzed. Two researchers independently identified, selected, and extracted data from the study and examined the risk of bias. The primary outcomes were students' examination scores (theoretical scores: scores obtained in the nursing fundamentals course, reflecting students' understanding and mastery of the course content; practical scores: assessment results based on practical application or experimental skills, evaluating students' practical skill level). The secondary outcomes were self-learning ability score: indicators assessing students' self-directed learning ability, reflecting their competence in independent learning and autonomous exploration; and satisfaction rate of teaching effect: the overall satisfaction rate of students with the teaching effects experienced during teaching process reflects the proportion of students' acceptance and satisfaction with the teaching program. The results were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) profiler software. The GRADE profiler software is used to assess and grade the recommendations according to the GRADE (Grading of Recommendations Assessment, Development, and Assessment) criteria.

Results

A total of 13 studies were included, consisting of 2,991 nursing students. Among them, 1,465 students were in the BOPPPS teaching group, while 1,526 students were in the traditional teaching group. The summary analysis of the main outcomes showed that the BOPPPS teaching model had significantly higher scores in theoretical score (MD = 3.35, 95% CI: 2.35-4.35, Z = 6.56, p < 0.00001), practice score (MD = 4.50, 95% CI: 1.95-7.05, Z = 3.45, p = 0.0006), and self-learning ability score (MD = 6.76, 95% CI: 5.38-8.14, Z = 9.60, p < 0.00001) compared to the traditional teaching group. The satisfaction rate of students in the BOPPPS teaching group regarding teaching effectiveness was 89% (95% CI = 0.84-0.93). The differences were statistically significant (p < 0.05). The GRADE evidence level for theoretical score and satisfaction rate of teaching effect is low. The evidence level for practice score is very low, and for self-learning ability score is moderate.

Conclusion

The BOPPPS teaching mode is helpful to improve the theoretical score, practice score, and self-learning ability score of "Fundamentals of Nursing," and improve the satisfaction rate of students to the teaching effect. The teaching effect is better than the traditional teaching method.

Educational game improves systems thinking, socialization, and teamwork among students of 13 health professions programs

Systems thinking and interprofessional collaborative practice competencies are critical to inculcate in students of health professions programs. The purpose of this study was to evaluate the impact that an interprofessional education (IPE) experience consisting of an educational game, Friday Night at the ER (FNER), and structured debriefing had on students' systems thinking and self-assessed interprofessional socialization and teamwork skills. Systems thinking was evaluated using the Systems Thinking Scale (STS), and interprofessional socialization and teamwork were evaluated using a modified Interprofessional Socialization and Valuing Scale-9 (ISVS-9) and Interprofessional Collaboration Competency Attainment Scale (ICCAS) question #21. This single-center study targeted students in 13 health professions programs. In the cohort (N of 626), Systems thinking increased significantly. Interprofessional socialization increased significantly, with a large effect size, and 485 (78%) students indicated their interprofessional collaborative practice competencies improved. Program evaluation data revealed students highly valued the experience and would recommend it to their peers. Based on our findings, an IPE experience consisting of FNER gameplay and structured debriefing can improve systems thinking and interprofessional socialization and teamwork in a large, diverse group of students of health professions programs.

Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs

BACKGROUND

Interprofessional (IP) socialization is important to develop early in the training of health professions students.

PURPOSE

This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER]).

METHODS

The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing.

RESULTS

IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development.

CONCLUSIONS

An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.

Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics

OBJECTIVE

to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics.

METHOD

methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8).

RESULTS

the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content.

CONCLUSION

the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Learning Italian as a Second Language in a Sample of Ukrainian Children: A Game-Based Learning Approach

Game-based learning is an educational approach aimed at acquiring knowledge through the use of play. There are various studies that note the effectiveness of playing as an educational tool and the use of digital platforms as a tool that can increase its effectiveness. We wanted to investigate whether a game-based learning approach may determine an improvement in Italian as a foreign language in terms of vocabulary expansion. The sample consists of 48 Ukrainian children between 6 and 7 years old. There were 24 female children and 24 male children in the sample, divided into two groups: the control group (Gr1) learnt Italian through frontal lessons (traditional approach), the experimental group (Gr2) learnt Italian through games and activities (game-based learning). The results have shown that the experimental group had a major increase in Italian vocabulary. However, both groups had an increase in this sense. Game-based learning remains an effective and promising educational approach, but other variables must be taken into account. Furthermore, the scarcity of literature on foreign language learning through game-based learning creates the need for more studies.

Mobile learning in nursing education: A bibliometric analysis and visualization

AIM

This study performed a bibliometric analysis of studies related to mobile learning in the field of nursing education.

METHODS

The Scopus database was used to determine the most frequently cited studies on mobile learning in nursing education. VOSviewer and Bibliometrix were employed for bibliometric analysis and visualization. Science mapping and performance analysis was adopted from bibliometric analysis techniques. In addition, a synthetic knowledge synthesis approach was used.

RESULTS

A total of 234 publications were published in 107 sources in 2002-2023. The publications had 8797 citations, an average of 88 citations per publication. In terms of total link strength (TLS), links, a number of articles and citations, the US led all other countries in the field. Regarding authors, Hwang was the most frequently cited authors (n = 348). According to trend topics analysis, the keywords "gamification", "simulation", "attitude", "clinical competence" and "online learning" have emerged in the field.

CONCLUSION

Research on mobile learning in nursing education has been increasing in recent years. The findings of this study can provide new ideas in the applications of mobile learning in nursing education to researchers or nursing faculties in the field.

The effectiveness of an Instagram-based educational game in a Bachelor of Nursing course: An experimental study

BACKGROUND

Gamification is a novel educational method that adopts elements of games to motivate students using participatory learning. The objective of this study was to measure the effect of participation in an Instagram-based educational game on learning outcomes.

METHOD

Experimental design with 291 university students in a first-year course of the Bachelor of Nursing during the 2020-21 academic year.

RESULTS

After ruling out pretest sensitization, we identified a positive effect of participation in the educational game. An average improvement of 0.62 points was observed in the final grade of the students belonging to the experimental groups.

CONCLUSION

Nursing undergraduate students participating an Instagram-based educational game had better learning outcomes than their counterparts who did not participate in the game.

Puzzle game-based learning: a new approach to promote learning of principles of coronary artery bypass graft surgery

INTRODUCTION

Since learning with high educational quality requires an advanced intervention. This study seeks to answer how many puzzles game-based training can improve knowledge and cognitive function of surgical technology students in CABG surgery and its sequence, as well as the tools and equipment used in each stage of surgery and the sequence of their preparation.

MATERIALS AND METHODS

This study was carried out as a quasi-experimental single-group pre-test-post-test, during which, after designing a puzzle game including various stages of surgery (from the preparation of the patient for surgical sutures and the necessary equipment to perform each stage), 18 people from third-year surgical technology students who met the inclusion criteria were entered in the study by convenience sampling method and based on the sample size determined using a similar study and they participated in the test of knowledge and cognitive function, that the validity and reliability were measured, before the intervention and 14 days after the intervention (using a puzzle game). Data were analyzed using descriptive and Wilcoxon statistical tests.

RESULTS

After the withdrawal of 2 people, 15 person (93.80 per cent) of the students were female, the average age of students was 21.87 ± 0.71 years, and 50% (8 people) of them were 22 years old. Also, the average score of the end-of-semester exam of the heart surgery technology course was 15.19 ± 2.30 (the lowest score was 11.25, and the highest score was 18.63), and the score of 43.80% (7 people) of them were in the range of 15.01-17.70, and their average of grade point average was 17.31 ± 1.10 (the lowest grade point average is 15 and the highest grade point average is 19.36) and grade point average 75% (11 people) of students were 16-18. The average scores of knowledge(5.75 ± 1.65 vs. 2.68 ± 0.79) and cognitive performance(6.31 ± 2.57 vs. 2.00 ± 1.09) of students in the post-intervention phase were significantly higher than the pre-intervention phase (P < 0.0001).

CONCLUSION

The results of the present study showed that the use of puzzle games in CABG surgery training led to a significant improvement in the knowledge and cognitive performance of surgical technology students regarding the stages of CABG surgery and its sequence, as well as the tools and equipment used in each stage of surgery and the sequence of their preparation.

Game-based learning in medical education

At present, medical education is rapidly evolving. Game-based learning (GBL) has been gradually used for education, and several innovations have emerged. The emergence of serious games and gamification provides alternative approaches for educators to improve the medical teaching process. Both serious games and gamification exert their education-promoting function by providing the possibility of combining learning activities such as feedback, testing, and spaced repetition with active participation and autonomy as well as positive experiences for students. Developing effective GBL modalities has the potential to bring immersive experiences for medical students and improve their study outcomes. Herein, we reviewed recent studies employing GBL in medical education, including serious games and gamification teaching. Furthermore, we also discussed the effectiveness and limitations of GBL to suggest future directions for the development and application of GBL in medical education.