Number of Citations: 0

Submitted: 19 August 2023
Accepted: 21 December 2023
Published online: 2 July, TAPS 2024, 9(3), 41-49
https://doi.org/10.29060/TAPS.2024-9-3/SC3111

Rosy Swee Cheng Tay¹, Debby Regina Wegner², Li Siong Lim³, Joshua Ting⁴ & Shu Ting Ong⁵

¹University of Glasgow Singapore, Singapore; ²Singapore Institute of Technology, Singapore; ³Singapore Institute of Technology, Singapore; ⁴Alexandra Health, Singapore; ⁵Gleaneagles Hospital, Singapore

Abstract

Introduction: The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module.  A hybrid approach was introduced using Game-Based Learning (GBL) to encourage active learning through gameplay. 

Methods: A Randomised Controlled Trial (RCT) was undertaken encompassing a cohort of 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in the 2021/22 academic year. The experimental group (n=27) worked through the online GBL intervention and the EBP module, while the control group (n=27) took the EBP module alone. The GBL included five Learning Quests and three case studies.

Results: High levels of satisfaction were reported by both the experimental group (n=22) and the control group (n=15) on the traditional content and delivery of the EBP module. High levels of engagement were reported by the experimental group on the GBL intervention; a one-sample statistics analysis confirming a significant level of engagement (p<0.001). A Mann-Whitney U Test, however, found no significant difference in the Continuous Assessment (CA) scores of the two groups (p=0.507 and 0.461). 

Conclusion: The introduction of GBL designed to deliver educational content directly associated with the learning outcomes increased the nursing student engagement in the EBP module. These findings and discoveries can be utilised to improve the GBL intervention to the EBP module to have a more positive impact the student CA scores and therefore on student learning.

Keywords:           Evidence-Based Teaching, Evidence-Based Practice (EBP), Nursing Education, Game-Based Learning (GBL), Teaching and Learning EBP, Nursing Students, Gamification

I. INTRODUCTION

The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module. Numerous undergraduate nursing programmes have taken a similar approach aimed at preparing students to be informed knowledge generators, rather than the more effective savvy consumers of research, or “evidence users” (Melnyk & Fineout-Overholt, 2019). These undergraduate nursing programmes continue to teach “traditional” nursing research courses that fail to address many of the skills, attitudes, and critical knowledge needed to foster EBP, doing little to promote the development of competencies critical for engaging in EBP in clinical contexts (Davidson & Candy, 2016).

EBP is mandated by the Singapore Nursing Board as a key entry to nursing practice competency (Singapore Nursing Board, n.d.) and yet new graduate nurses still lack the knowledge, skills, and attitudes that nurture EBP. In addition, the COVID-19 pandemic brought about unprecedented challenges when classes moved from face-to-face to online, with one of the side-effects being a marked deterioration in the active engagement of the students in their classes. Active engagement is seen as critically pertinent to the learning development of nursing students in preparing them to be future-ready graduates.

Gamification, or the application of game design elements like levels and badges to non-game activities, has been avidly adopted to support contextual teaching and learning, assignments, and assessments in efforts to strengthen student creativity and retention (Caponetto et.al., 2014). Although, as reported by Tavares (2022), results have been varied, Game-Based Learning (GBL) is being increasingly utilized in nursing education.  The aim of this short communication is to describe the development and evaluation of an innovative teaching strategy to evaluate student satisfaction, perception, level of engagement, and overall achievement of the learning outcomes via the gamification of the EBP module.

II. METHODS

A Randomised Controlled Trial (RCT) was undertaken using the 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in Trimester 3 of the 2021/22 academic year. All the students were invited to participate in the study and complete the Informed Consent form. The participants were randomized into either the experimental/ intervention group (n=27) or the control group (n=27).

The control group attended the traditional EBP module made up of lectures, workshops, and seminars. The intervention group completed both the EBP module and the GBL intervention. The web-based, mobile-optimized GBL was composed of five levels or Learning Quests (LQs) and three case studies. The LQs followed six different EBP steps (Melnyk & Fineout-Overholt, 2019), with each LQ calling for increasing levels of knowledge and proficiency to cultivate a spirit of inquiry for the undergraduate nursing students. The intervention group was informed to access the GBL only after the key EBP concepts and teaching were delivered to both groups.

Two surveys were used to evaluate participant satisfaction, perception, level of engagement, and overall achievement of the learning outcomes. At the end of the trimester, a university-wide Module and Teaching Feedback survey (Appendix 1) was used to assess how satisfied both groups were with teaching and learning within the EBP module. The GBL Module Learning Outcomes Feedback survey was to get a sense of how the intervention group evaluated the effectiveness of the four main GBL outcomes (Appendix 2).

III. RESULTS

A total of 54 students out of the 100 (54%) taking the EBP module agreed to participate in this study. A total of 22 (81.5%) participants from the intervention group and 15 (55.6%) from the control group completed the surveys. There was a 44.4% attrition from the control group.

A. Grade Performance

There were two types of Continuous Assessment (CA) used – a group presentation worth 40% of the total grade, and an individual essay worth 60%. For the group presentation the mean score and standard deviation of the intervention group was 79.56 (3.70) and the control group was 78.70 (4.03). For the essay, the mean score and standard deviation of the intervention group was 69.6 (11.93) and for the control group was 67.81 (10.76). The Mann Whitney U Test found that there was no significance difference between the CA scores of the intervention and control groups (p = 0.507 and 0.461).

B. Level of Satisfaction

Overall, there was a high level of satisfaction for the EBP module for both groups (intervention: 95.5%; control: 93.3%) with no significant difference (p=0.658) found between the two groups.

C. Level of Perception

Both groups demonstrated similar positive perceptions about the EBP module. 5 themes emerged from the thematic analysis of the open-ended questions (Table 1)

D. Level of Engagement

The GBL was reported by the students to have deepened their learning of EBP. 4 themes emerged from a thematic analysis of the open-ended questions (Table 1).

Table 1. Themes and associated subthemes

Note. This table lists the themes and associated subthemes that were identified from the student responses to the open-ended questions under perception and engagement. Selected student comments are included.

IV. DISCUSSION

There were several key findings from the development of GBL for the EBP module. Although no significant difference was found on the CA grade performance between the groups, both groups expressed a high level of satisfaction upon completing the EBP module.

Despite facing challenges with the usual didactic approach of teaching and learning of EBP, participants expressed appreciation to the faculty for the close stepwise guidance and prompt feedback in facilitating synergistic class teamwork. The systematic flow helped create a positive perception of the module delivery. This well-structured learning scaffold also provided a solid foundation for writing their Honours Thesis.

Gamification using case studies provided good interactivity for applied learning to enhance student engagement and learning. With regards to the interface itself, the navigation of the case studies via the user interface was found to be challenging, so side-by-side scrolling can be considered to improve future user experience.  Standardizing teaching and instructional methods to manage student expectations can also be considered, as there was definite support for moving the EBP module towards game-based learning.

This development of GBL for the EBP module was an innovative hybrid approach to the teaching pedagogy of the educational and healthcare institutions in Singapore. The employment of both didactic and GBL teaching and learning served to enhance the learning experience of the students and helped clarify the future translation of EBP into their respective clinical practice. While the feedback from the intervention group indicated the GBL interface can be improved, the high levels of satisfaction and engagement experienced by this group demonstrated the incorporation of game mechanics in the design of a teaching-learning process can help engage learners in a more productive learning experience.

With no significant difference between the grades of the two groups, it could be argued that the nursing students are already being well guided and supported by Faculty in the teaching and learning of EBP and that the intervention was built upon a firm foundation. Leveraging upon authentic digital learning with a sound pedagogical approach, however, can help to further promote critical thinking, active engagement, and positive learning experiences for the nursing students. Future enhancement to the GBL intervention can consider levelling up the basis of gamifying learning for higher immersive learning experience.  As there was a high attrition from the control group of 44.4%, future studies can consider a larger sample size for better generalizability. As this study only employed the GBL after the key concepts and teaching of EBP was delivered, future studies can consider the teaching and learning pedagogy of GBL along with seminar sessions to evaluate its viability.

V. CONCLUSION

This research project was carried out at the Singapore Institute of Technology to assess the impact of a GBL intervention on teaching and learning in the EBP module for nursing students. Despite no significant differences in grades between the groups, the results show the intervention had a positive impact on the student engagement, satisfaction, and perception of the learning experience, offering an excellent option of combining traditional didactic teaching with the innovative approach of GBL to enhance the EBP teaching and learning of undergraduate nursing students and healthcare professionals in both educational and healthcare institutions.

Notes on Contributors

Assistant Professor Rosy Tay Swee Cheng spearheaded the development of this research project, conducted the survey and data analysis, contributed to the conception, drafted, and critically revised the manuscript.

Ms. Debby Regina Wegener is a Senior Librarian and assisted with the development of a part of this research project, and critically revised the manuscript.

Mr. Lim Li Siong is a Senior Educational Developer in CoLEAD and coordinated the development of the research project and contributed to the critical review of the manuscript.

Mr. Joshua Ting is a Staff Nurse, Alexandra Health and played a key role in the development, conducted the survey and data analysis of this research project, and assisted in the critical review of the manuscript.

Ms. Ong Shu Ting is a Staff Nurse, Gleneagles Hospital and played a key role in the development, conducted the survey and data analysis of this research project, and assisted in the critical review of the manuscript.

All authors gave their final approval and agreed to be accountable for all aspects of the work.

Ethical Approval

Ethical approval approved by Singapore Institute of Technology (SIT) Review Board (IRB Project No. 2021157).

Data Availability

As per institutional policy, research dataset is available on reasonable request to the corresponding author.

Acknowledgement

The authors would like to thank Adjunct Associate Professor Edward Poon, Singapore Institute of Technology (SIT) for his invaluable support to the research project and Tam Yew Chung, Centre for Learning Environment and Assessment Development (CoLEAD), SIT for his advice and invaluable support in navigating the funding process.  

Funding

Funding (WBS Code: P-ALI-A203-0008) was received from Applied Learning and Innovation Grant (ALIGN), CoLEAD, SIT for the development of this web-based EBP game-based learning.  

Declaration of Interest

The authors declare no conflict of interest.

References

Caponetto, I., Earp, J., & Ott, M. (2014). Gamification and education: A literature review. European Conference on Games Based Learning, 1, 50–57.  

Davidson, S. J., & Candy, L. (2016). Teaching EBP using game-based learning: Improving the student experience. Worldviews on Evidence-Based Nursing, 13(4), 285–293. https://doi.org/10.1111/wvn.12152

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4^th ed.). Wolters Kluwer.

Singapore Nursing Board. (n.d.). Guidelines and Standards. https://www.healthprofessionals.gov.sg/snb/guidelines-and-standards  

Tavares, N. (2022). The use and impact of game-based learning on the learning experience and knowledge retention of nursing undergraduate students: A systematic literature review. Nurse Education Today, 117, Article 105484. https://doi.org/10.1016/j.nedt.2022.105484 

*Rosy Tay Swee Cheng
University of Glasgow, Singapore,
10 Dover Drive, Singapore 138683
+65 6592 4521
Email: rosy.tay@glasgow.ac.uk