ArticlePublisher preview available

Virtual Gaming Simulation in Nursing Education: A Focus Group Study

Journal of Nursing Education

May 2017
56(5):274-280

DOI:10.3928/01484834-20170421-04

Authors:

Margaret Anne Verkuyl

Centennial College

Michelle Hughes

Centennial College

Lorraine Betts

George Brown College

Show all 6 authorsHide

Background The use of serious gaming in a virtual world is a novel pedagogical approach in nursing education. A virtual gaming simulation was implemented in a health assessment class that focused on mental health and interpersonal violence. The study's purpose was to explore students' experiences of the virtual gaming simulation. Method Three focus groups were conducted with a convenience sample of 20 first-year nursing students after they completed the virtual gaming simulation. Results Analysis yielded five themes: (a) Experiential Learning, (b) The Learning Process, (c) Personal Versus Professional, (d) Self-Efficacy, and (e) Knowledge. Conclusion Virtual gaming simulation can provide experiential learning opportunities that promote engagement and allow learners to acquire and apply new knowledge while practicing skills in a safe and realistic environment. [J Nurs Educ. 2017;56(5):274–280.]

A preview of this full-text is provided by SLACK.

Learn more

Content available from Journal of Nursing Education

This content is subject to copyright.

ABSTRACT

Background: The use of serious gaming in a virtual

world is a novel pedagogical approach in nursing educa-

tion. A virtual gaming simulation was implemented in a

health assessment class that focused on mental health

and interpersonal violence. The study’s purpose was to ex-

plore students’ experiences of the virtual gaming simula-

tion. Method: Three focus groups were conducted with a

convenience sample of 20 rst-year nursing students after

they completed the virtual gaming simulation. Results:

Analysis yielded ve themes: (a) Experiential Learning, (b)

The Learning Process, (c) Personal Versus Professional, (d)

Self-Ecacy, and (e) Knowledge. Conclusion: Virtual gam-

ing simulation can provide experiential learning opportu-

nities that promote engagement and allow learners to ac-

quire and apply new knowledge while practicing skills in a

safe and realistic environment. [J Nurs Educ. 2017;56(5):274-

280.]

Simulation offers a safe learning environment for nursing

students to apply knowledge, advance their skills, and re-

ﬂect on clinical decision making while receiving imme-

diate feedback (Hayden, Smiley, Alexander, Kardong-Edgren,

& Jeffries, 2014; Nelson, 2016). Many types of simulation ex-

ist, including high ﬁdelity, often set in a laboratory (Cant &

Cooper, 2009; McGovern, Lapum, Clune, & Schindel-Martin,

2013); however, challenges are involved, such as costs related

to creating, operating, and maintaining simulation laboratories

(Gates, Parr, & Hughen, 2012). Other nontraditional simulation

approaches in nursing education include computerized virtual

learning using Second Life® and avatar-based programs, as well

as serious gaming modalities (De Gagne, Oh, Kang, Vorder-

strasse, & Johnson, 2013; Nelson, 2016; Tiffany & Hoglund,

2016). Although these tools offer novelty and are adaptive to

student learning, a paucity of research that examines students’

experiences of virtual gaming simulation exists.

Games have been integrated into nursing curricula for many

years to motivate students and increase knowledge retention, as

well as to promote active learning, problem solving, and critical

thinking skills (Royse & Newton, 2007). More recently, com-

puterized serious gaming has been used as a way to actively

engage students and support learning (Johnston, Boyle, MacAr-

thur, & Manion, 2013). Through a virtual world, students par-

ticipate in a clinical scenario on a computer screen. The advan-

tages of online serious gaming include its vast accessibility, its

potential to provide individualized learning adaptive to student

responses, and the preservation of patient safety. Evidence has

indicated that virtual gaming can be used as a tool to promote

student engagement and advance problem-solving and deci-

sion-making capacity (Duff, Miller, & Bruce, 2016).

The current study explored student experiences of a virtual

gaming simulation (VGS) of a community home visit that was

part of a health assessment course in a collaborative undergrad-

uate nursing program across three institutional sites. The year-

long health assessment course included an in-person lecture and

a laboratory component. In addition, 3 weeks were completed

via online modalities. VGS was one of the online modalities

that students completed independently. Students were provided

in-person instructions before completing the VGS and opportu-

nities to ask questions or make comments about the activities.

All students received a .05% mark of a ﬁnal course grade if

Virtual Gaming Simulation in Nursing

Education: A Focus Group Study

Margaret Verkuyl, NP-PHC, MN; Michelle Hughes, MEd, RN;

Joyce Tsui, MN, RN; Lorraine Betts, MN, RN; Oona St-Amant, PhD, RN;

and Jennifer L. Lapum, PhD, RN

Received: October 7, 2016

Accepted: January 5, 2017

Ms. Verkuyl, Ms. Hughes, and Ms. Tsui are Professors, Collaborative

Nursing Degree Program, Centennial College; Ms. Betts is Nursing Pro-

fessor, Saly Horsfall Eaton School of Nursing, George Brown College;

Dr. St-Amant is Assistant Professor, and Dr. Lapum is Associate Professor,

Daphne Cockwell School of Nursing, Ryerson University, Toronto, On-

tario, Canada.

The authors thank Ryerson University’s G. Raymond Chang School

of Continuing Education for assisting in the development of the virtual

gaming simulation. The authors also thank Interpersonal Skills Teach-

ing Centre: Live-actor Simulation Program for contributing to the virtual

gaming simulation, the Centennial College School of Community and

Health Studies for funding this study, and the nursing students who con-

tributed their time to participate in the study.

Address correspondence to Margaret Verkuyl, NP-PHC, MN, Profes-

sor, Collaborative Nursing Degree Program, Centennial College, PO Box

631, Station A, Toronto, Ontario, Canada, M1K 5E9; e-mail: MVerkuyl@

centennialcollege.ca.

doi:10.3928/01484834-20170421-04

Empowering undergraduate nursing students through simulation in mental health nursing curricula: A scoping review

Article

Jan 2025

Usability Evaluation of a Board Game for Learning Robotics of Care

Article

Full-text available

Apr 2025

Gamification and game-based learning provide the opportunity to acquire knowledge and skills on a given subject in a practical and interactive way. They are an innovative teaching methodology that could be used for competence acquisition in a variety of fields. This study focuses on two domains: technology (including robotics) and care. This study evaluates the usability of RobotCareMaker®, a board game designed to teach care robotics, a branch of robotics oriented towards the study of human care. RobotCareMaker® consists of 106 elements. The playing cards are the engine of the game and the element of interaction between players. A convenience sample was selected. Usability was evaluated by the System Usability Scale (SUS) questionnaire modified for the game, and three questions about the game experience were used. Using a modified SUS questionnaire, 21 participants rated it with an excellent score of 80.36. Over 90% found the instructions clear and error-free. RobotCareMaker® allows teachers, professionals, and nursing students to integrate curricular competencies in novel topics such as care robotics. The result suggests that RobotCareMaker® enhances learning in assistive robotics, improving competencies in education and healthcare.

Present and Future Trends of Virtual Simulation in Education: A Bibliometric Analysis

Article

Full-text available

Mar 2025

Virtual simulation is a system that integrates multi-source information, interactive three-dimensional dynamic visualization, and entity behavior. It has introduced innovations in educational concepts and revolutionized teaching methods, technology, content, as well as spatial and temporal dynamics. This research presents a comprehensive bibliometric analysis of the literature on virtual simulation in education. The primary aim is to provide a detailed overview of the current state and future prospects of this field. To achieve this, the study examines existing research trends and anticipates future directions using a bibliometric approach. A dataset comprising 982 journal articles was extracted from the Web of Science database for analysis. Through co-citation and keyword co-occurrence analyses, the study identifies influential publications, outlines the knowledge structure, and forecasts future trends. The co-citation analysis revealed five distinct clusters, while the keyword co-occurrence analysis identified four clusters. Despite the increasing importance of virtual simulation research, further scholarly efforts are required to comprehensively understand the research landscape in education. This article offers significant insights into the burgeoning field of virtual simulation in education and provides a thorough exploration of its potential for continued development in educational contexts.

Participating experience of virtual reality teaching among nursing students: a meta-synthesis of qualitative studies

Article

Full-text available

Mar 2025
BMC Nurs

Objective To systematically evaluate research on nursing students’ experience of participating in teaching virtual reality technology. Methods A computerized search of PubMed, Web of Science, Wiley Online Library, China Knowledge Network, Wanfang Database, CINAHL(Cumulative Index to Nursing and Allied Health Literature), and China Biomedical Literature Service System was conducted to search for qualitative studies on nursing students’ experiences of participating in teaching with virtual reality technology, with a time frame from 2013 to 2023. The quality of the Literature was evaluated using the quality evaluation criteria of Australian JBI evidence-based healthcare centers, and the results were summarized and integrated using the aggregative integration method. Results A total of 9 studies were included, ultimately distilling 37 findings from the original studies, which were outlined to form 7 new categories, yielding three integrated findings: strengths and needs of virtual reality teaching and learning experiences; weaknesses and challenges of virtual reality teaching and learning experiences; and future applications and possibilities of virtual reality teaching and learning. Conclusion By combining the advantages of virtual reality technology with the occurrence of nursing teaching, nursing students can experience immersive experiential learning at any time and any place without time and space constraints, and the overall cognitive pleasure of nursing students to this virtual teaching system is good. However, it is necessary to enrich further the details of teaching content design and optimize virtual reality’s technical experience.

Teaching high quality paediatric basic life support to laypeople: The development and evaluation of a virtual simulation game

Article

Full-text available

Jan 2025

Background Self-directed training has been recognized as a reasonable alternative to traditional instructor-led formats to teach laypeople Basic Life Support (BLS). Virtual tools can facilitate high-quality self-directed resuscitation education; however, their role in teaching paediatric BLS remains unclear due to limited empiric evaluation and suboptimal design of existing tools. Aim We describe the development and evaluation of a virtual simulation game (VSG) designed to teach high-quality paediatric BLS using a self-directed, online format with integrated deliberate practice and feedback. Methods We conducted a pilot prospective single-arm cohort study examining the VSG’s impact on laypeople’s paediatric BLS self-efficacy, attitudes, and knowledge as well as learner reactions. Data was collected using online surveys immediately after VSG completion and was analysed using descriptive statistics. Results Fifty-five participants (median age 32 years, 76% female, 11% active certification in paediatric BLS) evaluated the VSG. Participants reported high self-efficacy, willingness to perform paediatric BLS, and high perceived knowledge after VSG completion. Fifty (91%) achieved a passing score (≥13/15) on the paediatric BLS knowledge assessment. Learner reactions were favourable with 98% of participants agreeing that VSG educational content was clear and helpful. Mean System Usability Scale score was 81.1 (standard deviation 12.6) with a Net Promoter Score of 32 indicating high levels of usability and likelihood to recommend to others. Conclusions The VSG was well-received by laypeople with positive effects observed on paediatric BLS self-efficacy, attitudes, and knowledge. Future studies should examine the impact of VSGs on skill performance through standalone or blended learning approaches.

Reimagining the Virtual Patient Crafting Game-inspired Interactive Stories for Compassion Training

Thesis

Full-text available

Dec 2024

Miranda Verswijvelen

Interactive stories for learning (ISL) are a powerful pedagogical approach, well supported by learning theory and scholarly research. Learners traverse a story which reflects their real-life environment, make decisions and explore diverse narrative paths, learning from the consequences of their actions. It is a safe space for learners to practice, where failures function as learning opportunities. Despite their potential, ISL often fail to engage learners effectively due to poor execution. Learning designers face the challenge of ensuring narrative engagement while enhancing learner capability, but may lack the necessary skills to craft high-quality interactive stories. This gap is particularly clear when the ISL deals with intricate human interactions, such as healthcare provider-patient conversations. Scholars advocate for better narratives to enhance the potential of ISL in healthcare-referred to as virtual patients-for teaching non-technical skills, including empathy and compassionate care. However, crafting advice is scarce and fragmented, and too focused on learning from linear, not interactive storytelling. This study endeavoured to enhance ISL by learning the craft from narrative design in video games, where expertise and innovation in producing high-quality interactive narratives has been fostered since the earliest games, more than 50 years ago. In the first phase of this research, disseminations from narrative design experts were collected, analysed and synthesised. The expert advice emphasised the pivotal role of emotions and player self-expression in crafting interactive narrative, along with the importance of designing believable characters and meaningful choices. A comprehensive heuristics framework to craft ISL was developed based on the insights from this phase. Through iterative prototyping and reflection, the heuristics framework was evaluated and refined, and subsequently applied to the recrafting of a virtual patient for compassion training. The recrafted and original version were presented to nurses in the final phase of this study. An online survey measured the participants' narrative transportation in the virtual patient story and asked about their learner experience. Additionally, their decision-making during playthroughs was recorded. While no statistically significant differences for narrative transportation were found, the results from the playthrough data and open-ended questions demonstrated that incorporating emotional depth into virtual patient design significantly impacted learner engagement and empathy. Participants exhibited more compassionate care when interacting with the recrafted virtual patient, showing highly improved decision-making to promote patient outcomes. This study contributes valuable insights into leveraging game narrative techniques to enhance the crafting of virtual patients for compassionate care training. By bridging the gap between learning design and game narrative expertise, educators can create more immersive and effective ISL experiences, ultimately enhancing learner outcomes and experiences. 3

Develop and Evaluate Intelligent Immersive Virtual Reality Educational Tool in Gerontological Nurse Workforce

Article

May 2025
INT J HUM-COMPUT INT

Opportunities for Quality Improvement Through a Simulation-Based Mastery Learning Curriculum for Interprofessional Central Venous Care: Foundational Support

Article

Jan 2025
J Assoc Vasc Access

Ashley E. Franklin

Highlights Simulation-based mastery learning allows for time-variable practice. Mastery learning includes a pretest, deliberate practice, and a posttest. Learners meet minimum passing standards to move on to the next training stage.

Action research on the integration of panoramic VR interactive teaching materials into emergency nursing for vocational school students

Conference Paper

Mar 2025

DEBRIEFING IN SIMULATION-BASED LEARNING IN NURSING EDUCATION

Article

Full-text available

Feb 2025

Simulation-based learning (SBL) is an instructional technique designed to engage learners and foster the development of knowledge, attitudes, practical skills, critical thinking, and decision-making in nursing practice. Debriefing is a crucial component of SBL that enables learners to achieve learning objectives and integratetheoretical knowledge with clinical nursing practice. This is accomplished through structured reflection, analytical thinking, problem-solving, and performance evaluation. The learner-centered approach ensures that scenarios are tailored to the learners’ levelsof knowledge and experience. Facilitators mustpossess a deep understanding of the scenarios and demonstrate skills in providing constructive feedback, guiding reflective discussions, active listening, using open-ended questions, and offering rationales to support decision-making.Moreover, facilitators should createa psychologically safe environment to maximize learning outcomes. To enhance the debriefing process inSBL, widely accepted models such as the Gather, Analyze, Summarize (GAS) Model and the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework are recommended. These models provide clear structures and effective methodologies for conducting debriefing, encouraging systematic analytical thinking, and supporting learners in achieving the desired learning outcomes.

Second Life Virtual Learning in Public Health Nursing

Article

Full-text available

Sep 2016
J NURS EDUC

Background With limited available public health nursing clinical placements, nurse educators are challenged to create alternative learning experiences that engage students. Method Nursing faculty developed three Second Life® virtual learning scenarios in family health, disaster preparedness, and home safety areas of interest as a supplement to clinical experiences for undergraduate senior nursing students in a public health nursing course. Student perceptions of their learning were evaluated by a survey and focus group. Results Although students perceived learning public health nursing knowledge, they were less likely to agree that the experience was as effective for learning about public health nursing when compared with on-site clinical experiences. Conclusion The use of Second Life is an effective learning platform for teaching undergraduate nursing students public health nursing when clinical experiences are difficult to obtain. Nursing faculty need to ensure technological challenges are addressed and that scenarios are realistic, and engage students through interactive collaboration. [J Nurs Educ. 2016;55(9):536–540.]

Pictorial Narrative Mapping as a Qualitative Analytic Technique

Article

Full-text available

Dec 2015

Qualitative analysis is often a textual undertaking. However, it can be helpful to think about and represent study phenomena or narrative accounts in nontextual ways. In this article, we share our unique and artistic process in developing and employing pictorial narrative mapping as a qualitative analytic technique. We recast a nontextual, artistic-analytic technique by combining elements related to narrative mapping and narrative art. This technique involves aesthetic attunement to data and visual representation through pictorial design. We advanced this technique in the context of a narrative study about how arts-informed dissemination methods influence health-care practitioners' delivery of care. We found that the Pictorial Narrative Mapping process prompted an aesthetic and imaginative experience in the analytic process of qualitative inquiry. As an analytic technique, Pictorial Narrative Mapping extends the inquiry process and enhances rigor through artistic means as well as iterative and critical dialogue. Additionally, pictorial narrative maps can provide a holistic account of the phenomenon under study and assist researchers to make meaning of nuances within complex narratives. As researchers consider employing Pictorial Narrative Mapping, we recommend that they draw upon this technique as a malleable script yielding to an organic process that emerges from both their own data and analytic discussions. We are further curious about its imaginative capacities in social and health science literature, its possibilities in other disciplinary contexts, and the prospects of what Maxine Greene refers to as becoming more wide awakein our case, in future research analytic endeavors.

The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

Article

Full-text available

Jul 2014

Virtual Gaming Simulation for Nursing Education: An Experiment

Article

May 2017

Background Increasingly, simulation is replacing some clinical hours as nursing schools struggle to find quality clinical placements for students. Methods An experimental study was conducted to compare a virtual gaming simulation with a laboratory simulation regarding three outcomes: students' pediatric knowledge, self-efficacy, and satisfaction. Results Both groups made modest knowledge gains. They made significant gains in self-efficacy scores with the gaming group making greater gains. Satisfaction survey scores were high for both groups. Conclusions Virtual gaming simulation combined with hands-on simulation could become part of the suite of best teaching and learning practices we offer students. © 2017 International Nursing Association for Clinical Simulation and Learning

Virtual gaming to develop students’ pediatric nursing skills: A usability test

Article

Aug 2016

Background: As competition for specialty clinical placements increases, there is an urgent need to create safe, stimulating, alternative learning environments for students. Objective: To address that clinical gap, our team developed a virtual game-based simulation to help nursing students develop their pediatric nursing skills. Design: A usability study was conducted using the Technology Acceptance Model as a research framework. Setting and participants: The study was conducted at a community college and included nursing students, nursing faculty/clinicians and two gaming experts. Methods: The two experts evaluated the game using a heuristic checklist after playing the game. Participants engaged in a think-aloud activity while playing the game and completed a survey and interview based on the Technology Acceptance Model to explore ease of use and utility of the game. Results: We found a high degree of user satisfaction with the game. Students reported that they had learned about pediatric care, they had become immersed in the game and they were keen to keep playing. Several design changes were recommended. Conclusion: Usability testing is critical in the early stages of simulation development and the study provided useful direction for the development team in the next stage of game development.

Online Virtual Simulation and Diagnostic Reasoning: A Scoping Review

Article

Sep 2016

Background: Virtual reality technology can range from bedside learning to computerized tools accessed exclusively online; yet there is little evidence of the effectiveness of online virtual simulation for teaching diagnostic reasoning to health care providers. To address this gap, an examination of virtual simulation encounters in the online classroom was undertaken to inform education of a variety of health care providers, including nurse practitioners, registered nurses, and physicians. Method: Arskey and O'Malley's (2005) framework was the methodology used to conduct the scoping review. Result: Twelve studies published between 2008 and 2015 were identified from a search of 14 databases. The study sample included physicians and medical students (seven), baccalaureate nursing students (two), associate degree nursing students (one), and providers from other fields such as pharmacists, physiotherapists, sports medicine, forensics, and veterinarians. Conclusion: Online virtual simulation was comparable or superior to traditional simulation methods where increased engagement with learning occurred in a safe environment with convenient access. © 2016 International Nursing Association for Clinical Simulation and Learning.

Simulation based learning in midwifery education: a systematic review

Article

Jan 2011

Focus Group Methodology: Principles and Practice

Book

Jan 2011

Pranee Liamputtong

Using Virtual Simulation to Teach Inclusivity: A Case Study

Article

Apr 2016

Background: The topics of inclusivity, diversity, and cultural awareness are difficult to adequately explore in a traditional classroom setting. The use of the virtual platform of Second Life® afforded a unique opportunity to use virtual role-play simulation to experience what it is like to walk in another's shoes. Method: Fifteen graduate nurse educator students enrolled in a course titled "Inclusivity in Nursing Education" were randomly assigned a customized avatar, representing a marginalized person for use in a role-play simulation in the virtual world of Second Life®. Two written assignments regarding the learning experience were evaluated using a simple qualitative analysis. Results: Students indicated that they increased their own capacity to understand, appreciate, and relate to people different from themselves. Conclusion: Although future research is needed to determine the full extent to which virtual platforms can be used effectively in nursing education, this case study demonstrated that valuable learning regarding complex topics can take place in the virtual world. © 2016 International Nursing Association for Clinical Simulation and Learning.

The clinical learning environment in nursing education: A concept analysis

Article

Dec 2015
J ADV NURS

AimThe aim of this study was to report an analysis of the clinical learning environment concept. Background Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice. DesignThe clinical learning environment was investigated using Walker and Avant's concept analysis method. Data sourcesA literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014. Methods All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept. ResultsThe clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence. Conclusion With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role.