Educational games developed for students in perioperative nursing: A systematic review and appraisal of the evidence

Effectiveness of gamification in nursing degree education

Background

Previous research in nursing has found favorable results from the use of teaching methodologies alternative to lectures. One of the complementary methodologies used for university teaching is gamification, or the inclusion of game elements, creating a dynamic learning environment that allows the acquisition of knowledge and the development of other skills necessary for nursing students. The purpose of this study was to evaluate the effect of a gamification session on student satisfaction and knowledge scores in nursing students in simulated laboratory practice.

Methods

A pre-post quasi-experimental study was conducted with 122 students from the nursing degree program who participated in the research. The evaluation consisted of four sessions of three hours each. In two sessions, participants were trained through a vertical methodology, by means of theoretical training provided by teaching staff, and two hours of clinical simulation, where the students were able to practice the techniques on professional simulators. At the other two sessions, participants received an explanation of the theoretical aspects of the session, one hour of clinical simulation, and one hour of gamification, in which they had to pass tests based on the performance of practical activities on the subject of the session. At the end of the gamification session, all the participants received a certificate as winners of the "nursing game".

Results

There was an improvement in the satisfaction and the knowledge level in the gamification sessions. Both were statistically significant (P < 0.001). There was an improvement in the items related to the development of critical thinking and the mobilizing concepts from theory to practice in the gamification sessions.

Conclusion

The intervention was effective in improving the satisfaction of the sessions received and in knowledge development.

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

AIM

To investigate game-based learning in nursing education and summarize findings of its impact on nursing students' learning outcomes.

BACKGROUND

Nurses are the first point of contact for care and make up the largest proportion of the global health workforce. To respond effectively to the care needs of the population, nurses need to be adequately trained during their professional education. Game-based learning is increasingly becoming a strategy to complement simulation strategies in nursing education.

DESIGN

A systematic review of mixed-methods studies.

METHODS

A search was conducted in the electronic databases Medline, PubMed, Science Direct, Scopus and Web of Science. Quantitative, qualitative and mixed methods studies on nurse education published in English between 2000 and 2020 were considered. The Mixed Methods Assessment Tool was used for quality assessment. Data abstraction and synthesis was performed using a data extraction form.

RESULTS

A total of 46 studies from the 15 countries were included. The included studies were eight quantitative randomized controlled trials, 12 quantitative non-randomized controlled trials, 15 quantitative descriptive, five qualitative and six mixed methods studies. The results showed that game-based learning was used for many different courses or content in nursing education. Simulation games were the most used game type. Game-based learning facilitated the achievement of learning outcomes primarily in the cognitive domain. Some gamification elements and design-related aspects of game-based environments were evaluated as positive and negative. Game-based learning is a useful approach to assessing learning outcomes in only three studies.

CONCLUSION

Game-based learning is a useful method to achieve learning outcomes mainly in the cognitive domain, with some positive and negative aspects. Further research should investigate the effects of games on affective and behavioral learning outcomes, as well as the use of games to assess learning outcomes. Potential limitations of this review are that some studies could not be identified because of access issues and that some studies included participants other than nursing students.

Comparison of the effects of virtual training by serious game and lecture on operating room novices' knowledge and performance about surgical instruments setup: a multi-center, two-arm study

BACKGROUND

Game-based training is increasingly implemented in different nursing fields, as it allows students to learn experientially, with the flexibility to regulate their training based on their personal progresses and abilities. This study aimed to compare the effects of virtual training by the "Playing with Surgical Instruments (PlaSurIn)" game and the lecture on the surgical instruments setup knowledge and performance of Operating Room (OR) novices.

METHODS

This study was conducted on 51 s-semester undergraduate OR technology students taking the course "An Introduction to Surgical Instruments and Equipment." An additional virtual training session was held via a learning management system using two different methods. The students of the Game Training Group (GTG, n = 27) played individually with the "PlaSurIn" game during a week, while the students of the Lecture Training Group (LTG, n = 24) received the lecture-based training during a week. To measure knowledge, all the students participated in a theoretical test with 10 multiple-choice questions before and immediately after the training. They also participated in an Objective Structured Clinical Examination (OSCE) after the training, and their performance was evaluated by the remained time for setup completion and the scores, errors, and bonuses.

RESULTS

The mean score of the theoretical test was significantly higher in the GTG than in the LTG after the training (p = 0.040). Additionally, the GTG participants had higher scores (p = 0.016), fewer errors (p = 0.001), and higher bonuses (p = 0.011) compared to the LTG ones. The remained time for setup completion was also significantly longer in the GTG than in the LTG (p < 0.001).

CONCLUSION

Virtual training by "PlaSurIn" was superior to the lecture-based method for the enhancement of surgical instruments setup knowledge and performance amongst OR novices.

Learning experiences of game-based educational intervention in nursing students: A systematic mixed-studies review

BACKGROUND

To meet the evolving needs of today's nursing students and the demand for 21st century skills in modern healthcare, game-based learning has received increasing attention. It can improve learning outcomes, while enhancing learning experiences by promoting engagement and motivation.

OBJECTIVE

To explore the learning experiences of using game-based education in nursing students.

DATA SOURCES

Electronic databases of PubMed, EMBASE, Cochrane Library, CINAHL (EBSCOhost), and Scopus were searched from inception till January 2021.

REVIEW METHODS

Quantitative, qualitative, and mixed-methods studies were included, involving the use of games for education among nursing students. Both published and unpublished studies in English language without restrictions to the year of publication. Methodological quality of included studies was assessed using the mixed methods appraisal tool. Data synthesis used a convergent synthesis approach. Narrative synthesis was used for quantitative findings and thematic synthesis for qualitative findings. A result-based convergent synthesis was adopted to integrate both results.

RESULTS

A total of 53 studies were included among 4612 nursing students across 16 countries. These included 32 quantitative studies, 7 qualitative studies, and 14 mixed-methods studies, with methodological quality ranging from low to high. The findings from this review demonstrate that game-based education interventions can enhance nursing students' learning experiences. Three themes emerged from both quantitative and qualitative syntheses: 1) motivators of learning, 2) facilitators of engagement, and 3) affective response.

CONCLUSIONS

Game-based education is promising in promoting positive learning experiences among nursing students. This can better inform educators and healthcare leaders when considering gaming as an alternative education approach in motivating and engaging students in learning. Future research should provide greater focus on examining the use of specific games under similar contexts.

"Playing with Surgical Instruments (PlaSurIn)" game to train operating room novices how to set up basic surgical instruments: A validation study

BACKGROUND

Game-based training has been considered as an alternative modality to traditional training in different perioperative nursing fields.

OBJECTIVES

To describe the adaptation and validation process of "Playing with Tweezers", a Portuguese game developed for novices to set up basic surgical instruments on the Mayo stand or a back table.

DESIGN

A validation study with three phases of translation, reconciliation, and evaluation (face, content, and construct validity).

SETTINGS

Several medical universities in Iran.

PARTICIPANTS

Twelve students in a pilot translation test, 18 experts in the reconciliation phase, 20 experts in the face and content validity stages, and 120 students (72 novices, 26 intermediates, and 22 experts) in the construct validity stage.

METHODS

Following "forward-backward" translation from Portuguese to English, the English version of the game was appraised in the reconciliation phase using a 57-item questionnaire. To test face and content validity of the final version of the game, a 30-item questionnaire addressing different aspects of the game was completed. The students' game performance (remained time for game completion, obtained score, and error) was compared to assess the construct validity.

RESULTS

Minor differences were detected and resolved during the translation process. The English version of the game was reconciled in two sequential steps, and the final game called "Playing with Surgical Instruments (PlaSurIn)" was developed. All the items regarding the face validity received 80-100% of positive responses. Moreover, regarding the content validity, all of the evaluated items obtained a content validity index of 0.90-1.0. Compared to the novices, the experts and intermediates received higher scores (p < 0.001 in two cases) and fewer errors (p < 0.001, p = 0.007). The remained time for game completion was significantly longer for experts than the novices (p = 0.011).

CONCLUSIONS

The "PlaSurIn", as a virtual training strategy, can prepare novices to set up basic surgical instruments.