Effectiveness of the <i>serious game</i> for learning in nursing: systematic review

Nascimento, Kleiton Gonçalves do; Ferreira, Maria Beatriz Guimarães; Felix, Márcia Marques dos Santos; Nascimento, Juliana da Silva Garcia; Chavaglia, Suzel Regina Ribeiro; Barbosa, Maria Helena

doi:10.1590/1983-1447.2021.20200274

Kleiton Gonçalves do Nascimento

Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências da Saúde, Programa de Pós-Graduação stricto sensu em Atenção à Saúde. Uberaba, Minas Gerais, Brasil.

https://orcid.org/0000-0002-2717-6837

Maria Beatriz Guimarães Ferreira

Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências da Saúde, Programa de Pós-Graduação stricto sensu em Atenção à Saúde. Uberaba, Minas Gerais, Brasil.

Universidade Federal de Uberlândia (UFU), Faculdade de Medicina, Curso de Graduação em Enfermagem. Uberlândia, Minas Gerais, Brasil.

https://orcid.org/0000-0003-4487-9232

Márcia Marques dos Santos Felix

Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências da Saúde, Programa de Pós-Graduação stricto sensu em Atenção à Saúde. Uberaba, Minas Gerais, Brasil.

https://orcid.org/0000-0001-8431-6712

Juliana da Silva Garcia Nascimento

Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Programa de Pós Graduação em Enfermagem Fundamental. Ribeirão Preto, São Paulo, Brasil.

https://orcid.org/0000-0003-1118-2738

Suzel Regina Ribeiro Chavaglia

Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências da Saúde. Departamento Didático-Científico de Enfermagem na Assistência Hospitalar. Uberaba, Minas Gerais, Brasil.

https://orcid.org/0000-0001-7033-0185

Maria Helena Barbosa

Universidade Federal do Triângulo Mineiro (UFTM), Instituto de Ciências da Saúde. Departamento Didático-Científico de Enfermagem na Assistência Hospitalar. Uberaba, Minas Gerais, Brasil.

https://orcid.org/0000-0003-2749-2802

Corresponding author:
Maria Helena Barbosa Email: mhelena331@hotmail.com

Authorship contribution

Conceptualization; Formal Analysis; Investigation; Methodology; Project administration; Resources; Validation; Visualization; Writing-original draft; Writing-review & editing: Kleiton Gonçalves do Nascimento.

Formal Analysis; Investigation; Methodology; Resources; Validation; Visualization; Writing-original draft; Writing-review & editing: Márcia Marques dos Santos Felix; Maria Beatriz Guimarães Ferreira; Juliana da Silva Garcia Nascimento; Suzel Regina Ribeiro Chavaglia.

Conceptualization; Formal Analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Supervision; Validation; Visualization; Writing-original draft; Writing-review & editing: Maria Helena Barbosa.

Associate editor

Carlise Rigon Dalla Nora

Editor-in-chief

Maria da Graça Oliveira Crossetti

Libraries and databases	Search strategy
PubMed^® and Scopus	("Students, Nursing" OR “Pupil Nurses” OR “Student, Nursing” OR “Nurses, Pupil” OR “Nurse, Pupil” OR “Pupil Nurse” OR “Nursing Student” OR “Nursing Students”) AND ("Video Games" OR “Game, Video” OR “Games, Video” OR “Video Game” OR “Computer Games” OR “Computer Game” OR “Game, Computer” OR “Games, Computer” OR “Serious Game”) AND ("Teaching" OR “Training Techniques” OR “Technique, Training” OR “Techniques, Training” OR “Training Technique” OR “Training Technics” OR “Technic, Training” OR “Technics, Training” OR “Training Technic” OR “Pedagogy” OR “Pedagogies” OR “Teaching Methods” OR “Method, Teaching” OR “Methods, Teaching” OR “Teaching Method” OR “Academic Training” OR “Training, Academic” OR “Training Activities” OR “Activities, Training” OR “Training Activity” OR “Techniques, Educational” OR “Technics, Educational” OR “Educational Technics” OR “Educational Technic” OR “Technic, Educational” OR “Educational Techniques” OR “Educational Technique” OR “Technique, Educational”) AND (“Knowledge” OR “Epistemology”).
CINAHL	("Students, Nursing" OR "Nursing Student" OR "Nursing Students" OR "Student Nurses" OR "Student, Nursing") AND ("Video Games" OR "Game, Video" OR "Games, Video" OR "Video Game" OR Serious Game) AND (“Teaching Methods”) AND (Knowledge OR “Health Knowledge”).
Web of Science	(Students, Nursing AND Video Games OR Serious Game AND Teaching AND Knowledge).
LILACS	("Estudantes de Enfermagem" AND “Jogos de Vídeo” AND “Serious Game” AND “Educação em Enfermagem” AND Conhecimento); (“Students, Nursing” AND “Video Games” AND “Serious Games” AND “Education, Nursing” AND Knowledge); (“Estudiantes de Enfermería” AND “Juegos de Video” AND “Serious Game” AND “Educación en Enfermería” OR “Educação em Enfermagem AND Conocimiento).

Authors and title	Serious game learning objectives and skills developed by nursing students	Intervention	Outcomes and recommendations/conclusion
Fonseca et al.2121. Fonseca LM, Aredes ND, Fernandes AM, Batalha LM, Apóstolo JM, Martins JC, et al. Computer and laboratory simulation in the teaching of neonatal nursing: Innovation and impact on learning. Rev Latino-Am Enfermagem. 2016;24:e2808. doi: https://doi.org/10.1590/1518-8345.1005.2808 https://doi.org/10.1590/1518-8345.1005.2... Computer and laboratory simulation in the teaching of neonatal nursing: Innovation and impact on learning.	To understand the clinical evaluation of oxygenation of preterm newborns in the Neonatal Intensive Care Unit. Skills: cognitive (knowledge) and affective (satisfaction).	Quasi-experimental study with 14 students. Intervention: use of Serious game e-Baby. The experimental group (n=7) was submitted to the serious game; the control group (n=7) was submitted to laboratory simulation.	The serious game showed a statistically significant difference (p=0.001) in cognitive skill. The students were satisfied with the game. There was an improvement in knowledge and satisfaction. The nursing serious game is recommended.
Tan et al.2222. Tan AJ, Lee CC, Lin PY, Cooper S, Lau LS, Chua WL, et al. Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: a randomized controlled trial. Nurse Educ Today. 2017;55:38-44. doi: https://doi.org/10.1016/j.nedt.2017.04.027 https://doi.org/10.1016/j.nedt.2017.04.0... Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial.	To know and apply the blood transfusion procedure and the specific care given to the transfusion reaction. Skills: cognitive (knowledge), psychomotor, (procedural) and affective (confidence).	Randomized experimental study with 103 students. Intervention: use of a serious game on blood transfusion. The experimental group (n=57) performed the serious game associated with lectures; the control group (n=46) was submitted to lectures.	There was a significant improvement (p<0.001) in the knowledge of the experimental group, high psychomotor performance, however without statistical significance and development of confidence. It is recommended to adopt the serious game to develop cognitive, psychomotor, and affective skills in nursing.
Bayram et al.2323. Bayram SB, Caliskan N. Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: a randomized controlled trial. Nurse Educ Today. 2019;79:25-31. doi: https://doi.org/10.1016/j.nedt.2019.05.010 https://doi.org/10.1016/j.nedt.2019.05.0... Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: A randomized controlled trial.	To know and apply nursing care for tracheostomized patients. Skills: cognitive (knowledge) and psychomotor (procedural).	Experimental, randomized study with 86 students. Intervention: serious game about tracheostomy care. The experimental group (n=43) was submitted to serious game, expository classes and laboratory training. The control group (n=43) to expository class and laboratory training.	There was no statistically significant difference for knowledge between the groups (p>0.05), however, the scores of psychomotor skills were higher for the experimental group (p=0.017). The serious game is recommended for learning in nursing.
Boada et al.2424. Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, Olivet J, Carreras V, Sbert M. Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Programs Biomed. 2015;122(2):282-91. doi: https://doi.org/10.1016/j.cmpb.2015.08.006 https://doi.org/10.1016/j.cmpb.2015.08.0... Using a serious game to complement CPR instruction in a nurse faculty.	To know and apply the care of a cardiorespiratory arrest by means of cardiopulmonary resuscitation. Skills: cognitive (knowledge) and psychomotor (procedural).	Experimental, randomized study with 109 students. Intervention: LISSA serious game for teaching cardiorespiratory arrest. The experimental group (n=67) performed the serious game, expository class and laboratory training. The control group (n=42) expository class and laboratory training.	The experimental group obtained significantly better knowledge scores (p<0.05) than the control group. The intervention group also showed improvement in psychomotor skills. The use of LISSA improves students’ knowledge and skills in CPR.
Aljezawi et al.2525. Aljezawi M, Albashtawy M. Quiz game teaching format versus didactic lectures. Br J Nurs. 2015;24(2):86,88-92. doi: https://doi.org/10.12968/bjon.2015.24.2.86 https://doi.org/10.12968/bjon.2015.24.2.... Quiz game teaching format versus didactic lectures	To understand the patient care organization models, including nursing care, teamwork, primary nursing care and case management. Skills: cognitive (knowledge) and affective (satisfaction)	Experimental, randomized study with 66 students. Intervention: use of the serious game. Experimental group (n=34) submitted to the serious game. Control group (n=32) expository class.	The students submitted to the game had significantly higher scores for knowledge (control group: 9.63±1.79; experimental group 11.34±2.17; p<0.001), and their retention (control group: 7.10±1.49; experimental group: 9.00±2.08; p<0.001). There was a statistically significant difference in the satisfaction of the intervention group (p<0.001). It is recommended to adopt the serious game for teaching.
LeFlore et al.2626. LeFlore JL, Anderson M, Zielke MA, Nelson KA, Thomas PE, Hardee G, et al. Can a virtual patient trainer teach student nurses how to save lives -- teaching nursing students about pediatric respiratory diseases. Simul Healthc. 2012;7(1):10-7. doi: https://doi.org/10.1097/SIH.0b013e31823652de https://doi.org/10.1097/SIH.0b013e318236... Can a virtual patient trainer teach student nurses how to save lives--teaching nursing students about pediatric respiratory diseases	To know the different signs and symptoms associated with pediatric respiratory diseases and the best care. Skills: cognitive (knowledge) and psychomotor (procedural)	Experimental, randomized study with 93 students. Intervention: serious game on pediatric ventilation. The experimental group (n=46) was submitted to serious game, reading and simulation in the laboratory. The control group (n=47) the lecture and simulation in the laboratory.	There was a significant difference in knowledge between the control and experimental groups (mean score 75±12 versus 83.9±15, respectively, p=0.004). The experimental group performed better in the tasks (p=0.001). It is concluded that the game can be effective for learning in nursing.

Domains	References
Domains	Fonseca et al.2121. Fonseca LM, Aredes ND, Fernandes AM, Batalha LM, Apóstolo JM, Martins JC, et al. Computer and laboratory simulation in the teaching of neonatal nursing: Innovation and impact on learning. Rev Latino-Am Enfermagem. 2016;24:e2808. doi: https://doi.org/10.1590/1518-8345.1005.2808 https://doi.org/10.1590/1518-8345.1005.2...	Tan et al.2222. Tan AJ, Lee CC, Lin PY, Cooper S, Lau LS, Chua WL, et al. Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: a randomized controlled trial. Nurse Educ Today. 2017;55:38-44. doi: https://doi.org/10.1016/j.nedt.2017.04.027 https://doi.org/10.1016/j.nedt.2017.04.0...	Bayram et al.2323. Bayram SB, Caliskan N. Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: a randomized controlled trial. Nurse Educ Today. 2019;79:25-31. doi: https://doi.org/10.1016/j.nedt.2019.05.010 https://doi.org/10.1016/j.nedt.2019.05.0...	Boada et al.2424. Boada I, Rodriguez-Benitez A, Garcia-Gonzalez JM, Olivet J, Carreras V, Sbert M. Using a serious game to complement CPR instruction in a nurse faculty. Comput Methods Programs Biomed. 2015;122(2):282-91. doi: https://doi.org/10.1016/j.cmpb.2015.08.006 https://doi.org/10.1016/j.cmpb.2015.08.0...	Aljezawi et al.2525. Aljezawi M, Albashtawy M. Quiz game teaching format versus didactic lectures. Br J Nurs. 2015;24(2):86,88-92. doi: https://doi.org/10.12968/bjon.2015.24.2.86 https://doi.org/10.12968/bjon.2015.24.2....	Leflore et al.2626. LeFlore JL, Anderson M, Zielke MA, Nelson KA, Thomas PE, Hardee G, et al. Can a virtual patient trainer teach student nurses how to save lives -- teaching nursing students about pediatric respiratory diseases. Simul Healthc. 2012;7(1):10-7. doi: https://doi.org/10.1097/SIH.0b013e31823652de https://doi.org/10.1097/SIH.0b013e318236...
Study design	Non-randomized: 2	Randomized: 3	Randomized: 3	Randomized: 3	Randomized: 3	Randomized: 3
Sampling: center and response rate	One institution: 0.5 50%‐74% rate: 1	One institution: 0.5 and >75% rate: 1.5	One institution: 0.5 and 50%‐74% rate: 1	One institution: 0,5 and >75% rate: 1.5	One institution: 0.5 and >75% rate: 1.5	One institution: 0.5 and >75% rate: 1.5
Type of assessment	Objective: 2	Objective: 2	Objective: 2	Objective: 2	Objective: 2	Objective: 2
Instrument validity	Not reported: 0	Internal structure: 1 Content: 1	Internal structure: 1 Content: 1	Not reported: 0	Content: 1	Content: 1
Data analysis	Appropriate: 1 Beyond descriptive analysis: 2	Appropriate: 1 Beyond descriptive analysis: 2	Appropriate: 1 Beyond descriptive analysis: 2	Appropriate: 1 Beyond descriptive analysis: 2	Appropriate: 1 Beyond descriptive analysis: 2	Appropriate: 1 Beyond descriptive analysis: 2
Outcomes	Knowledge and skill: 1.5 Affective skills: 1	Knowledge and skill: 1,5 Affective skills: 1	Knowledges and skills: 1.5	Knowledge and skill: 1.5 Affective skills: 1	Knowledge and skill: 1.5 Affective skills: 1	Knowledges and skills: 1.5
Total Score	11	14.5	13	12.5	13.5	12.5

[1] Corresponding author:
Maria Helena Barbosa Email: mhelena331@hotmail.com

Brasil

Brasil

Effectiveness of the serious game for learning in nursing: systematic review

Eficacia del juego serio para el aprendizaje en enfermería: revisión sistemática

ABSTRACT

Objective

Method

Results

Conclusion