Advertisement

From experiencing to critical thinking: a contextual game-based learning approach to improving nursing students’ performance in Electrocardiogram training

  • Ching-Yi Chang
  • Chien-Huei Kao
  • Gwo-Jen HwangEmail author
  • Fu-Huang Lin
Development Article
  • 59 Downloads

Abstract

The Electrocardiogram (ECG) is one of the important tools for diagnosing myocardial infarction. The ECG training course aims to help nurses establish basic competence in interpreting ECG readings. However, in traditional instruction, learners usually have difficulty memorizing the meanings of different ECG wave forms, which could represent clinical symptoms, or even life-threatening conditions/arrhythmia. Some serious problems could cause death if the nursing staff do not make correct judgments in time. This paper reports an explorative study which investigated a novel pedagogy for nursing school students’ ECG learning performance using a contextual game. A 2 week experiment was conducted to compare the learning performances of the nursing students who played the ECG contextual game and those who learned with traditional instruction. The experimental results show that the students learning with the contextual game showed better learning performance, attitude, motivation, and critical thinking tendency than those who received the traditional instruction.

Keywords

Digital game-based learning Contextual learning Critical thinking Nursing education 

Notes

Acknowledgements

This study is supported in part by the Ministry of Science and Technology of the Republic of China under contract number MOST-108-2511-H-011-005-MY3.

Compliance with ethical standards

Conflict of interest

The authors would like to declare that there is no conflict of interest in this study.

References

  1. Al-Azawi, R., Al-Faliti, F., & Al-Blushi, M. (2016). Educational gamification vs. game based learning: Comparative study. International Journal of Innovation, Management and Technology,7(4), 132–136.Google Scholar
  2. Alba, B. (2018). Factors that impact on emergency nurses’ ethical decision-making ability. Nursing Ethics,25(7), 855–866.CrossRefGoogle Scholar
  3. All, A., Castellar, E. P. N., & van Looy, J. (2015). Towards a conceptual framework for assessing the effectiveness of digital game-based learning. Computers & Education,88, 29–37.CrossRefGoogle Scholar
  4. All, A., Castellar, E. P. N., & van Looy, J. (2016). Assessing the effectiveness of digital game-based learning: Best practices. Computers & Education,92, 90–103.CrossRefGoogle Scholar
  5. Anderson, R., Manoogian, S. T., & Reznick, J. S. (1976). The undermining and enhancing of intrinsic motivation in preschool children. Journal of Personality and Social Psychology,34(5), 915.CrossRefGoogle Scholar
  6. Arnab, S., Lim, T., Carvalho, M. B., Bellotti, F., De Freitas, S., Louchart, S., et al. (2015). Mapping learning and game mechanics for serious games analysis. British Journal of Educational Technology,46(2), 391–411.CrossRefGoogle Scholar
  7. Atwood, D., & Wadlund, D. L. (2015). ECG Interpretation Using the CRISP Method: A Guide for Nurses. AORN Journal,102(4), 396–408.CrossRefGoogle Scholar
  8. Bawa, P., Watson, S. L., & Watson, W. (2018). Motivation is a game: Massively multiplayer online games as agents of motivation in higher education. Computers & Education,123, 174–194.CrossRefGoogle Scholar
  9. Blakeman, J. R., Sarsfield, K., & Booker, K. J. (2015). Nurses’ practices and lead selection in monitoring for myocardial ischemia: An evidence-based quality improvement project. Dimensions of Critical Care Nursing,34(4), 189–195.CrossRefGoogle Scholar
  10. Bland, A. J., Topping, A., & Tobbell, J. (2014). Time to unravel the conceptual confusion of authenticity and fidelity and their contribution to learning within simulation-based nurse education. A discussion paper. Nurse Education Today,34(7), 1112–1118.CrossRefGoogle Scholar
  11. Bland, A. J., Topping, A., & Wood, B. (2011). A concept analysis of simulation as a learning strategy in the education of undergraduate nursing students. Nurse Education Today,31(7), 664–670.CrossRefGoogle Scholar
  12. Boada, I., Rodriguez-Benitez, A., Garcia-Gonzalez, J. M., Olivet, J., Carreras, V., & Sbert, M. (2015). Using a serious game to complement CPR instruction in a nurse faculty. Computer Methods and Programs in Biomedicine,122(2), 282–291.CrossRefGoogle Scholar
  13. Boyle, E. A., Hainey, T., Connolly, T. M., Gray, G., Earp, J., Ott, M., et al. (2016). An update to the systematic literature review of empirical evidence of the impacts and outcomes of computer games and serious games. Computers & Education,94, 178–192.CrossRefGoogle Scholar
  14. Brindley, C., & Scoffield, S. (1998). Peer assessment in undergraduate programmes. Teaching in Higher Education,3(1), 79–90.CrossRefGoogle Scholar
  15. Chai, C. S., Deng, F., Tsai, P. S., Koh, J. H. L., & Tsai, C. C. (2015). Assessing multidimensional students’ perceptions of twenty-first-century learning practices. Asia Pacific Education Review,16(3), 389–398.CrossRefGoogle Scholar
  16. Chang, B. Y., Chang, C. Y., Hwang, G. H., & Kuo, F. R. (2018a). A situation-based flipped classroom to improving nursing staff performance in advanced cardiac life support training course. Interactive Learning Environments,27(8), 1062–1074.CrossRefGoogle Scholar
  17. Chang, Y. H., Song, A. C., & Fang, R. J. (2018b). Integrating ARCS model of motivation and PBL in flipped classroom: A case study on a programming language. Eurasia Journal of Mathematics, Science and Technology Education,14, 12.Google Scholar
  18. Charlier, N., & De Fraine, B. (2013). Game-based learning as a vehicle to teach first aid content: A randomized experiment. Journal of School Health,83(7), 493–499.CrossRefGoogle Scholar
  19. Chee, Y. S., Mehrotra, S., & Ong, J. C. (2015). Professional development for scaling pedagogical innovation in the context of game-based learning: Teacher identity as cornerstone in “shifting” practice. Asia-Pacific Journal of Teacher Education,43(5), 423–437.CrossRefGoogle Scholar
  20. Chen, H. Y., Chang, C. K., & Lou, S. J. (2017). A study of high school mathematics teaching method: Maker-education combined with mathematical experiments. US-China Education Review,7(7), 336–347.Google Scholar
  21. Chen, C. P., Shih, J. L., & Ma, Y. C. (2014). Using instructional pervasive game for school children’s cultural learning. Educational Technology & Society,17(2), 169–182.Google Scholar
  22. Cheng, M. T., Chen, J. H., Chu, S. J., & Chen, S. Y. (2015). The use of serious games in science education: A review of selected empirical research from 2002 to 2013. Journal of Computers in Education,2(3), 353–375.CrossRefGoogle Scholar
  23. Chu, H. C., & Chang, S. C. (2014). Developing an educational computer game for migratory bird identification based on a two-tier test approach. Educational Technology Research and Development,62(2), 147–161.CrossRefGoogle Scholar
  24. Chu, H. C., Hwang, G. J., Tsai, C. C., & Tseng, J. C. R. (2010). A two-tier test approach to developing location-aware mobile learning systems for natural science courses. Computers & Education,55(4), 1618–1627.CrossRefGoogle Scholar
  25. Cioffi, J. (1999). Triage decision making: Educational strategies. Accident and Emergency Nursing,7(2), 106–111.CrossRefGoogle Scholar
  26. Connolly, T. M., Boyle, E. A., MacArthur, E., Hainey, T., & Boyle, J. M. (2012). A systematic literature review of empirical evidence on computer games and serious games. Computers & Education,59(2), 661–686.CrossRefGoogle Scholar
  27. 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.CrossRefGoogle Scholar
  28. de Oliveira, S. N., do Prado, M. L., Kempfer, S. S., Martini, J. G., Caravaca-Morera, J. A., & Bernardi, M. C. (2015). Experiential learning in nursing consultation education via clinical simulation with actors: Action research. Nurse Education Today,35(2), e50–e54.CrossRefGoogle Scholar
  29. DeBourgh, G. A. (2011). Psychomotor skills acquisition of novice learners: A case for contextual learning. Nurse Educator,36(4), 144–149.CrossRefGoogle Scholar
  30. del Blanco, Á., Torrente, J., Fernández-Manjón, B., Ruiz, P., & Giner, M. (2017). Using a videogame to facilitate nursing and medical students’ first visit to the operating theatre. A randomized controlled trial. Nurse Education Today,55, 45–53.CrossRefGoogle Scholar
  31. Dickey, M. D. (2007). Game design and learning: A conjectural analysis of how massively multiple online role-playing games (MMORPGs) foster intrinsic motivation. Educational Technology Research and Development,55(3), 253–273.CrossRefGoogle Scholar
  32. Dorji, U., Panjaburee, P., & Srisawasdi, N. (2015). A learning cycle approach to developing educational computer game for improving students’ learning and awareness in electric energy consumption and conservation. Journal of Educational Technology & Society,18(1), 91–105.Google Scholar
  33. Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare,2(2), 115–125.CrossRefGoogle Scholar
  34. Forneris, S. G., & Peden-McAlpine, C. J. (2006). Contextual learning: A reflective learning intervention for nursing education. International Journal of Nursing Education Scholarship,3(1), 1–17.CrossRefGoogle Scholar
  35. Foss, B., Løkken, A., Leland, A., Stordalen, J., Mordt, P., & Oftedal, B. F. (2014). Digital game-based learning: A supplement for medication calculation drills in nurse education. E-Learning and Digital Media,11(4), 342–349.CrossRefGoogle Scholar
  36. Fuller, C., Scott, C., Hug-English, C., Yang, W., & Pasternak, A. (2016). Five-year experience with screening electrocardiograms in National Collegiate Athletic Association Division I Athletes. Clinical Journal of Sport Medicine,26(5), 369–375.CrossRefGoogle Scholar
  37. Glaser, B. G., & Strauss, A. (1967). Discovery of grounded theory. Strategies for qualitative research. Mill Valley, CA: Sociology Press.Google Scholar
  38. Graham, A. S., & Williams, A. E. (2016). Foot health education for people with rheumatoid arthritis: ‘…. A Game of Chance…’ - A Survey of Patients’ Experiences. Musculoskeletal Care,14(1), 37–46.CrossRefGoogle Scholar
  39. Guo, Z. (2014). Based on the RMXP RPG game design and implementation. Advanced Materials Research,1044, 1102–1105.CrossRefGoogle Scholar
  40. Hoffman, B., & Nadelson, L. (2010). Motivational engagement and video gaming: A mixed methods study. Educational Technology Research and Development,58(3), 245–270.CrossRefGoogle Scholar
  41. Holly, C., Legg, T. J., Mueller, D., & Adelman, D. S. (2008). Online teaching: Challenges for a new faculty role. Journal of Professional Nursing,24(4), 254–258.CrossRefGoogle Scholar
  42. Hu, S. C., Kao, W. F., Yang, J. T., Lai, P. F., Zhang, X., Yan, H. Z., et al. (2016). Advance cardiac life support (5th ed.). New Taipei: Kingdom Publications.Google Scholar
  43. Huang, W. H., Huang, W. Y., & Tschopp, J. (2010). Sustaining iterative game playing processes in DGBL: The relationship between motivational processing and outcome processing. Computers & Education,55(2), 789–797.CrossRefGoogle Scholar
  44. Humphreys, M. (2013). Developing an educational framework for the teaching of simulation within nurse education. Open Journal of Nursing,3(4), 363–371.CrossRefGoogle Scholar
  45. Hwang, G. J., Yang, L. H., & Wang, S. Y. (2013). A concept map-embedded educational computer game for improving students’ learning performance in natural science courses. Computers & Education,69, 121–130.CrossRefGoogle Scholar
  46. Kafai, Y. B. (2006). Playing and making games for learning: Instructionist and constructionist perspectives for game studies. Games and Culture,1, 36–40.CrossRefGoogle Scholar
  47. Keough, V. A., Tell, D., Andreoni, C., & Tanabe, P. (2016). Unique educational needs of emergency nurse practitioners. Advanced Emergency Nursing Journal,38(4), 300–307.CrossRefGoogle Scholar
  48. Kiili, K. (2005). Digital game-based learning: Towards an experiential gaming model. Internet and Higher Education,8(1), 13–24.CrossRefGoogle Scholar
  49. Kilgour, P., Reynaud, D., Northcote, M. T., & Shields, M. (2015). Role-playing as a tool to facilitate learning, self-reflection and social awareness in teacher education. International Journal of Innovative Interdisciplinary Research,2(4), 8–20.Google Scholar
  50. Kurka, N., Bobinger, T., Kallmünzer, B., Koehn, J., Schellinger, P. D., Schwab, S., et al. (2015). Reliability and limitations of automated arrhythmia detection in telemetric monitoring after stroke. Stroke,46(2), 560–563.CrossRefGoogle Scholar
  51. Lad, T. S., Gorman, K., Watson, D., & Kennedy, D. (2014). A late presentation of dynamic ECG conduction abnormalities following blunt chest injury. Journal of the Intensive Care Society,15(1), 61–62.CrossRefGoogle Scholar
  52. Lee, L. C., & Hao, K. C. (2015). Designing and evaluating digital game-based learning with the arcs motivation model, humor, and animation. International Journal of Technology and Human Interaction,11(2), 80–95.CrossRefGoogle Scholar
  53. Lee, H., Parsons, D., Kwon, G., Kim, J., Petrova, K., Jeong, E., et al. (2016). Cooperation begins: Encouraging critical thinking skills through cooperative reciprocity using a mobile learning game. Computers & Education,97, 97–115.CrossRefGoogle Scholar
  54. Li, L. (2019). Using game-based training to improve students’ assessment skills and intrinsic motivation in peer assessment. Innovations in Education and Teaching International,56(4), 423–433.CrossRefGoogle Scholar
  55. Lin, Y. T. (2016). When mobile technology meets traditional classroom learning environment: How does it improve students’learning performances? Journal of Education Research,10(3), 249–262.Google Scholar
  56. Lin, K. C., Wei, Y. C., & Hung, J. C. (2012). The effects of online interactive games on high school students’ achievement and motivation in history learning. International Journal of Distance Education Technologies,10(4), 96–105.CrossRefGoogle Scholar
  57. Liu, T. Y., & Chu, Y. L. (2010). Using ubiquitous games in an English listening and speaking course: Impact on learning outcomes and motivation. Computers & Education,55(2), 630–643.CrossRefGoogle Scholar
  58. Malone, T. W. (1981). Toward a theory of intrinsically motivating instruction. Cognitive Science,5(4), 333–369.CrossRefGoogle Scholar
  59. McLaren, B. M., Adams, D. M., Mayer, R. E., & Forlizzi, J. (2017). A computer-based game that promotes mathematics learning more than a conventional approach. International Journal of Game-Based Learning (IJGBL),7(1), 36–56.CrossRefGoogle Scholar
  60. Mikkelsen, J., & Holm, H. A. (2007). Contextual learning to improve health care and patient safety. Education for Health,20(3), 124.Google Scholar
  61. Minami, Y., Haruki, S., Yashiro, B., Suzuki, T., Ashihara, K., & Hagiwara, N. (2016). Enlarged left atrium and sudden death risk in hypertrophic cardiomyopathy patients with or without atrial fibrillation. Journal of Cardiology,68(6), 478–484.CrossRefGoogle Scholar
  62. Mokhtar, N., Ismail, A., & Muda, Z. (2019). Designing model of serious game for flood safety training. International Journal of Advanced Computer Science and Applications,10(5), 331–339.CrossRefGoogle Scholar
  63. Morton, P. G. (2014). Detecting ventricular hypertrophy and atrial abnormality through the electrocardiogram. AACN Advanced Critical Care,25(4), 392–396.CrossRefGoogle Scholar
  64. O’Neill, L., Smith, K., Currie, P. F., Elder, D., Wei, L., & Lang, C. C. (2014). Nurse-led Early Triage (NET) study of chest pain patients: A long term evaluation study of a service development aimed at improving the management of patients with non-ST-elevation acute coronary syndromes. European Journal of Cardiovascular Nursing,13(3), 253–260.CrossRefGoogle Scholar
  65. Peters, M. (2000). Does constructivist epistemology have a place in nurse education? Journal of Nursing Education,39(4), 166–172.Google Scholar
  66. Prensky, M. (2001). Digital natives, digital immigrants part 2: Do they really think differently? On the Horizon,9(6), 1–6.CrossRefGoogle Scholar
  67. Prensky, M. (2007). Digital game-based learning. New York: McGraw-Hill.Google Scholar
  68. Prensky, M. (2012). Digital natives, digital immigrants. On the Horizon,9(5), 1–6.CrossRefGoogle Scholar
  69. Purchase, H. C. (2000). Learning about interface design through peer assessment. Assessment & Evaluation in Higher Education,25(4), 341–352.CrossRefGoogle Scholar
  70. Robertson, J., & Howells, C. (2008). Computer game design: Opportunities for successful learning. Computers & Education,50(2), 559–578.CrossRefGoogle Scholar
  71. Sanchez, S., De Boissieu, P., Gueyraud, C., Armingaud, D., Guerrier, M., & Denormandie, P. (2016). Information and communication technology and health of the elderly. Soins Gerontologie,21(121), 10–14.CrossRefGoogle Scholar
  72. Sherlin, M. M., & Quinn, P. T. (2016). End-of-Life patient simulation: Lessons learned. Teaching and Learning in Nursing,11(4), 184–188.CrossRefGoogle Scholar
  73. Shih, W. C., & Tseng, S. S. (2009). A knowledge-based approach to retrieving teaching materials for context-aware learning. Journal of Educational Technology & Society,12(1), 82–106.Google Scholar
  74. Shin, K. R. (1998). Critical thinking ability and clinical decision-making skills among senior nursing students in associate and baccalaureate programmes in Korea. Journal of Advanced Nursing,27(2), 414–418.CrossRefGoogle Scholar
  75. Simpson, J. M., & Elias, V. L. (2011). Choices and chances the sociology role-playing game—The sociological imagination in practice. Teaching Sociology,39(1), 42–56.CrossRefGoogle Scholar
  76. Soares, A. N., Gazzinelli, M. F., Souza, V. D., & Araújo, L. H. L. (2015). The Role Playing Game (RPG) as a pedagogical strategy in the training of the nurse: An experience report on the creation of a game. Texto & Contexto-Enfermagem,24(2), 600–608.CrossRefGoogle Scholar
  77. Su, C. H., & Cheng, C. H. (2015). A mobile gamification learning system for improving the learning motivation and achievements. Journal of Computer Assisted Learning,31(3), 268–286.CrossRefGoogle Scholar
  78. Triantafyllakos, G., Palaigeorgiou, G., & Tsoukalas, I. A. (2011). Designing educational software with students through collaborative design games: The we! design & play framework. Computers & Education,56(1), 227–242.CrossRefGoogle Scholar
  79. Walrath, J. M., Immelt, S., Ray, E. M., Van Graafeiland, B., & Dennison Himmelfarb, C. (2015). Preparing patient safety advocates: Evaluation of nursing students’ reported experience with authority gradients in a hospital setting. Nurse Educator,40(4), 174–178.CrossRefGoogle Scholar
  80. Wang, L. C., & Chen, M. P. (2010). The effects of game strategy and preference-matching on flow experience and programming performance in game-based learning. Innovations in Education and Teaching International,47(1), 39–52.CrossRefGoogle Scholar
  81. Werner, K., Kander, K., & Axelsson, C. (2014). Electrocardiogram interpretation skills among ambulance nurses. European Journal of Cardiovascular Nursing,15(4), 262–268.CrossRefGoogle Scholar
  82. Whitton, N. (2011). Game engagement theory and adult learning. Simulation & Gaming,42(5), 596–609.CrossRefGoogle Scholar
  83. Woda, A. A., Gruenke, T., Alt-Gehrman, P., & Hansen, J. (2016). Nursing student perceptions regarding simulation experience sequencing. Journal of Nursing Education,55(9), 528–532.CrossRefGoogle Scholar
  84. Wunder, L. L. (2016). Effect of a nontechnical skills intervention on first-year student registered nurse anesthetists’ skills during crisis simulation. AANA Journal,84(1), 46–51.Google Scholar
  85. Yoo, I. Y., & Lee, Y. M. (2015). The effects of mobile applications in cardiopulmonary assessment education. Nurse Education Today,35(2), e19–e23.CrossRefGoogle Scholar
  86. Yu, M., & Kang, K. J. (2017). Effectiveness of a role-play simulation program involving the sbar technique: A quasi-experimental study. Nurse Education Today,53, 41–47.CrossRefGoogle Scholar
  87. Yurdaarmagan, B., Melek, C. G., Merdenyan, B., Cikrikcili, O., Salman, Y. B., & Cheng, H. I. (2015). The effects of digital game-based learning on performance and motivation for high school students. ICIC Express Letters,9(5), 1465–1469.Google Scholar
  88. Zadeh, N. R., Gandomani, H. S., Delaram, M., & Yekta, Z. P. (2015). Comparing the effect of concept mapping and conventional methods on nursing students’ practical skill score. Nursing and Midwifery Studies,4(3), 1–6.Google Scholar
  89. Zeng, R., Yue, R. Z., Tan, C. Y., Wang, Q., Kuang, P., Tian, P. W., et al. (2015). New ideas for teaching electrocardiogram interpretation and improving classroom teaching content. Advances in Medical Education and Practice,6, 99.CrossRefGoogle Scholar
  90. Zulkosky, K. D., White, K. A., Price, A. L., & Pretz, J. E. (2016). Effect of simulation role on clinical decision-making accuracy. Clinical Simulation in Nursing,12(3), 98–106.CrossRefGoogle Scholar

Copyright information

© Association for Educational Communications and Technology 2019

Authors and Affiliations

  1. 1.Department of Midwifery and Women Health CareNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
  2. 2.Graduate Institute of Digital Learning and Education, National Taiwan University of Science and TechnologyTaipeiTaiwan
  3. 3.School of Public HealthNational Defense Medical CenterTaipeiTaiwan

Personalised recommendations