Authored by Klaudia Ćwiękała Lewis*
Background
Background: Technological applications, games and simulations are already extensively incorporated into the traditional educational process. Lately, the interest in investigating games and simulation use in nursing education has been amplified. The alteration, from lecture-centered to student-centered environments and the growing use of games as innovative learning technologies, demands a renovation in nursing education. In regard to this, games and simulations are projected to play an important part in the nursing learning process. Virtual simulation and gaming offer a sustainable, lucrative teaching alternative for nursing students and nursing educators.
Objectives: The purpose of this paper is to discuss present Advantages and Disadvantages of utilizing games and simulation for designing learning experiences for nursing.
Methods: An electronic database search was conducted of five electronic databases PubMed, CINAHL, Web of Science, Embase, and Google Scholar (January, 2007 – December, 2019) limited to English. Studies that discuss application of games and/or simulation for designing learning experiences for nursing students and educators.
Results: The search strategy identified 168 papers of which 34 were retrieved for full review. Nineteen articles were removed based on the exclusion/inclusion criteria, leaving 18 articles for final analysis. During this literature review this author noted three key advantages and three key disadvantages.
Keywords: Games; Simulations; Learning experiences; Nursing; Education
Introduction
The term video game generally means the interaction of games played utilizing a specialized electronic device or any other type of screen that it is programmed on (video game, n.d.). The term ‘video game,’ has been recorded in history as early as 1948 with the invention of the “Cathode-Ray Tube Amusement device” (Brookhaven National Library, n.d.). This particular device utilized manual pictures placed on the screen as an overlay and the game was played under the overlay. In 1952 the first recorded, full-screen video game, without the picture overlay, was developed and titled “OXO” or a version of tic-tac-toe (Brookhaven National Library, n.d.) This device fully displayed the processed output of a game onto a screen. As the years and eventually decades progressed, video games have progressed from something that is played casually, to simulations, educational games, and full virtual reality types of games. Although in earlier times, video games had the stigma of being for pure entertainment value only, the literature has conveyed the utilization of video games, specifically in nursing, as early as the 1980’s [1]. This was preceded with the idea of multiple constraints with video games to use in nursing education. The primary reasoning was deeply rooted in the nursing tradition from the founder Florence Nightingale of being educated in the classroom and supported that method of education for nursing [1]. Secondary reasoning for the resistance to the utilization of video games in education stemmed around the lack of knowledge and research surrounding them as being utilized as an educational tool for nursing students. That is the main purpose of this paper, not to show that games can be utilized as a tool within the nursing education scheme, but rather to illustrate specific advantages and disadvantages of utilizing video games as presented within the articles based upon using gaming as an adjunct in the education of nursing students.
Methods
A literature search was conducted in two ways. First a systematic literature search was conducted using six popular health science databases. Secondly a Google Scholar (http://scholar.google.com/) search was conducted. The second search allowed the researcher to explore more publications in a less structured manner. During the second search, abstracts were reviewed carefully, as this database provides more low- quality material. The search was conducted to answer the research question: What advantages and disadvantages of using video games and simulations for designing learning experiences for the nursing student and educators are discussed in current literature? An electronic search was conducted of the published research studies examining the advantages and disadvantages of using video games and simulations for designing learning experiences for the nursing student and educators. Electronic databases included: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Embase, from January, 2007 to December, 2019. Search terms included: “Video Games” or “Gaming Simulation” AND “Nursing Education”. Articles were limited to English. The abstracts of all research studies were reviewed to determine the relevance to the presented topic.
Results
The search of five databases yielded 138 articles for screening for potential inclusion. After removing duplicate articles and those not related to the topic, a total of 34 studies were reviewed in depth for eligibility. The 34 articles were reviewed based on inclusion and/or exclusion criteria, yielding 18 articles included in this review (Figure 1). illustrates the study selection process. Fifteen articles were examined to create a list of potential advantages and disadvantages of using games and simulations for designing learning experiences for nursing students and educators.
Advantages and Disadvantages
Advantages
The researched articles that were found revealed a vast amount of information pertaining to video game usage with the education of nursing students. Upon further examination, specifically looking for the advantages of using games, the following list was developed based upon the main themes of the articles presented.
• Errors are not harmful to patients
• Simulated training leads to clinical improvement
• Video games allow for specific designs and patient interactions specific to a specialized skillset
This author will delve further into the explanation of these advantages in relation to the research that presented the concepts of utilizing video games in nursing education.
Errors are not harmful to patients: Medical errors are a very serious problem within the United States of America’s healthcare system. Overall medical errors that involve all types of errors including physician, nurse and unlicensed professional errors account for over 130,000 patient deaths a year [2]. Specifically, pertaining to nursing, the majority of nursing errors are related to medication errors. It was deducted within a research study performed in 2009 that in upwards of 65% of nursing errors were related to medication errors [3]. These errors range from the occurrence of minor issues such as increased discomfort to more serious consequences such as allergic reactions and increased length of stay. There is, estimated to be, over $70 million a year of increased healthcare costs associated with medication errors alone [3].
The advantage of utilizing gaming in relation to errors is that gaming is not using real-life subjects. This alone is beneficial due to the fact that if a video game character has a medication error, a human is not harmed by that error. Robyn and Simon (2009), within their review, showed that 50% of their reviewed research studies pertaining to simulation had a significant effect on a nursing student’s confidence with their skills and critical thinking. Utilizing simulation for education assistance with nursing education can boost the nursing student’s confidence and critical thinking which can lead to fewer errors. One issue with clinical scenarios that may occur, according to Sleeper and Thompson[4], is that students may have a fear of performing skills or even communicating on how to perform skills due to the fear of causing harm to patients, even when in a supervised environment. Gaming and simulations can help quell those fears by providing an environment of no fear of harm to the patient. Multiple research articles specifically mention the importance of the creation of that type of environment of not harming a patient [1,5-12]. [5,9] continue to press that issue of errors not affecting humans and that simulations create a supervised session that allows the students to practice, experience and try new skills in different ways to help them learn how to perform those skills in a controlled manner. That can help decrease the anxiety related to trying new procedures and increase the comfort level of the students to try to learn more easily.
Simulated training leads to clinical improvement: Simulation and education are synonymous with each other to provide a new method of training outside of the traditional classroom method of education. This type of training helps expand the situation and knowledge that is being transferred to the student to allow for placement of the knowledge in a more realistic context [12,13]. The benefits to the simulation-type of education can be attributed to the idea that the students can retain more knowledge utilizing simulation versus the traditional classroom-type of style. In a classical work by Edgar Dale, he developed a ‘Cone of Experience’ that outlined the hypothetical amount of knowledge retained during an educational session. To simplify the cone, it lists the hypothetical percentage of knowledge retained with the various types of learning experiences beginning with (a) 10% of knowledge remembered with reading, (b) 20% of knowledge with what they hear, (c) 30% of knowledge remembered with what they see, (c) 50% of knowledge remembered with what they see and hear, (d) 70% of knowledge remembered of what they say and write, (e) 90% of knowledge remembered of what they do as they perform the task [14].
The simulation utilizes the knowledge learned and applies that directly towards a situation where the student can perform the action on a training dummy while ‘educating’ the instructor [15]. This method of learning and knowledge retention is up in the highest percentage, according to the cone of experience, which can translate into increased clinical competence [16]. This improvement in the clinical competency of the students has been researched fairly extensively over the years. In a Systemic Review of just 12 research studies surrounding the usage of simulationbased learning, Cant and Cooper [16] found that all 12 of the studies, consisting of a total sample size of 1533 study participants showed a significant improvement in the clinical competency of the research participants. In another study researching undergraduate nursing student’s experiences, they continued the trend of the increased knowledge and increased feeling of having better knowledge towards being able to perform their clinical functions within their skills [10].
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