The effect of game-based scenario writing on the clinical reasoning of internship nursing students in cardiovascular emergencies and critical care units

Abstract

Background: Nurses’ failure to properly apply clinical reasoning (CR) can result in diagnostic errors especially in cardiac emergencies and critical care that compromise patient care and threaten patient safety. Therefore, nursing education must employ appropriate teaching approaches, particularly throughout internships, to enhance students’ CR skills. Aim: This study aimed to assess the effect of game-based scenario writing on the CR of internship nursing students in cardiac emergencies and critical care units. Methods: An unblinded, randomized, controlled trial with a parallel control group was conducted with 82 nursing students who were experiencing cardiac emergencies and critical care internships from June to September 2023. The participants were randomly assigned to either the intervention group (n = 41), which received game-based scenario writing in the two phases of the pre-internship and internship periods, or the control group (n = 41), which received routine internship training. Data were collected at baseline and the end of the internship course, and the instruments included participants’ characteristics, a CR test, and a satisfaction questionnaire. Results: At the end of the cardiac emergencies and critical care internship course, compared with the control group, the intervention group presented a significant increase in CR (12.30 ± 3.6, 14.57 ± 3.9, p < 0.05). Within-group Comparison of pre-test and post-test CR scores only showed a significant increase in the intervention group (p = < 0.001). Conclusions: The current study’s findings support the argument that the gamified scenario-writing method can be an effective and dynamic learning method. It appears that employing this approach in nursing education could potentially enhance the CR of nursing students during their internship courses. Therefore, applying this method is recommended to nursing educators, especially for cardiac emergencies and critical care unit internship courses.