Evaluation of a Gamified Electronic Medication Administration Record (eMAR) System

Study Overview
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Brief Summary
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This research project will evaluate a gamified electronic medication administration record (eMAR) system simulator as a mechanism to improve students' learning of medication administration in simulated clinical education. The gamified eMAR simulator will be evaluated using a pragmatic randomized controlled trial design in order to determine the effectiveness of the game as a technology-enabled, online learning intervention.

Detailed Description
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The main objective of this study is to examine whether the use of a gamified medication administration simulator improves nursing students' medication administration safety within simulated practice; increases student self-efficacy and knowledge of the medication administration process; and, improves motivational and cognitive processing attributes related to student learning in a technology-enabled environment. It is hoped that by completing this trial, the effectiveness of using an eMAR simulator as an educational tool to better prepare nursing students to administer medications using eMAR technology for practice will be ascertained.

Official Title
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A Mixed-methods Evaluation of a Gamified Electronic Medication Administration Record (eMAR) System for Use in the Simulated Nursing Education

Conditions
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Nurse's Role, Medication Administered in Error, Simulation of Physical Illness

Intervention / Treatment
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* Device: eMAR game
* Other: Normal pre-work


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: (1) second year nursing students; and, (2) partaking in clinical simulated education in either in Fall 2017 or Winter 2018 semesters. Exclusion Criteria: (1) A student who is not enrolled the BScN program at the respective site of data collection, in Fall 2017 or Winter 2018.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: eMAR game<br>Participants provided access to eMAR simulator game in advance of simulated return-demonstration; also receive normal education pre-work related to eMAR administration | Device: eMAR game<br>* The eMAR simulator videogame affords students a virtual and immersive opportunity to practice medication administration using an eMAR system, in a structured fashion that provides real-time feedback related to best-practices and safety compliance of the medication process<br>Other: Normal pre-work<br>* Participants complete normal education pre-work related to eMAR administration, in advance of simulated return-demonstration<br>|
| Active Comparator: Normal pre-work<br>Participants receive normal education pre-work related to eMAR administration, in advance of simulated return-demonstration | Other: Normal pre-work<br>* Participants complete normal education pre-work related to eMAR administration, in advance of simulated return-demonstration<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of medication errors | Number medication errors generated by nursing students, as assessed by a previously modified researcher-developed rubric that assists observers to quantify the number of medication errors generated during a return-demonstration in clinical simulation (DOI:10.1097/NNE.0000000000000361 / 10.1016/j.ecns.2017.05.016). The quantity of medication errors are codified in six categories: infection control; assessment; verification; scan; administration; documentation. | weeks 6-9 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-efficacy of eMAR medication administration instrument | Self-efficacy of eMAR medication process will be assessed through a pre/post survey. The scale is 6 item scale (1=not confident; 7=absolutely confident). The higher the index, the higher an individual's perceived self-efficacy toward eMAR medication administration. Used as a pre/post test, this instrument will measure changes over time related to eMAR medication administration self-efficacy | weeks 4-9 | 
| Game motivational and cognitive attributes of participants instrument | Cross-sectional data will be collected using questions modified from the Huang et al. (2011) validated instrument that measures motivational (i.e., attention, relevance, confidence, satisfaction) and cognitive processing of learning in technology-enabled environments (20 questions, Cronbach's alpha = 0.91). This composite outcome is reported through tests of dimensionality, using a canonical correlational analysis, providing standardized coefficients between the instrument's sub-components. | week 9 | 
| Knowledge of eMAR medication administration instrument | Knowledge of eMAR medication process will be assessed through a pre/post survey. The scale is 8 item scale (1=not prepared; 7=absolutely prepared). The higher the index, the higher an individual's perceived knowledge toward eMAR medication administration. Used as a pre/post test, this instrument will measure changes over time related to eMAR medication administration knowledge | weeks 4-9 |