Development of an Educational Video Game to Improve Nursing Students' Reasoning With Acute Heart Failure Patients

Study Overview
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Brief Summary
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The aim of this study is to appreciate, using quantitative and qualitative empirical methods, the contribution of an educational video game to the engagement, the motivation, and the development of nursing students' interpretation of acute heart failure patients' health condition. Two prototypes of the same educational video game have been developed. Study participants will play with both prototypes, complete online questionnaires and be interviewed by a research assistant regarding their experience with both prototypes. Study results will serve to select the most promising prototype between the two, based on its potential to support the engagement, the motivation, and the development of nursing students' interpretation of acute heart failure patients' health condition. Study results will also serve to refine the selected prototype before conducting a larger-scale efficacy trial. As such and given the small sample number of participants that is expected, it is not planned to conduct hypothesis testing.

Official Title
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Development of a Serious Game to Improve Nursing Students' Clinical Reasoning in the Context of Acute Heart Failure

Conditions
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Heart Failure, Motivation

Intervention / Treatment
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* Other: SIGN@L-A
* Other: SIGN@L-B


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: As part of a Bachelor of Nursing program, to be registered in a course in which acute heart failure concepts are a focus. Exclusion Criteria: No exclusion criteria

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: Crossover Assignment
Interventional Model Description: The quantitative component is a two-group randomized crossover trial with 1:1 group allocation. Each participant will be randomly allocated to one of the two intervention sequences (i.e., the serious game SIGN@L-A followed by the serious game SIGN@L-B or vice versa). The randomization sequence list will be generated by an individual independent to quantitative data collection using an online program (randomizer.org). The primary investigator will not have access to this list. This individual will inform the primary investigator of participants' allocation after they have consented to be randomized, their randomization order based on the exact time they have completed the online consent form. Block randomization will be used with block sizes of six to avoid imbalances in group sizes.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: SIGN@L-A followed by SIGN@L-B<br>Participants in this arm will have access to the prototype SIGN@L-A of the serious game for seven days. They will have access to this prototype from their personal computer and will be able to play with it whenever they want and for how long they wish during this period. After these seven days, they will have access the same way to the prototype SIGN@L-B. | Other: SIGN@L-A<br>* Two prototypes of a serious game were developed as part of this study. The design of these prototypes is based on the conceptual model by Alexiou and Schippers (2018) linking the instructional design of a serious game to intrinsic motivation, engagement, and learning outcomes. The design of SIGN@L-A will include all elements of the serious game instructional design proposed by these authors which are game mechanics (i.e., objectives to meet, feedback, and rewards), a narrative (i.e., a protagonist, non-playable characters, and narrative events), and aesthetics (i.e., functional and hedonic aesthetics).<br>Other: SIGN@L-B<br>* The design of SIGN@L-B will include only some of these elements which are some of the game mechanics (i.e., objectives to meet, limited feedback), and a functional aesthetic.<br>|
| Experimental: SIGN@L-B followed by SIGN@L-A<br>Participants in this arm will have access to the prototype SIGN@L-B of the serious game for seven days. They will have access to this prototype from their personal computer and will be able to play with it whenever they want and for how long they wish during this period. After these seven days, they will have access the same way to the prototype SIGN@L-A. | Other: SIGN@L-A<br>* Two prototypes of a serious game were developed as part of this study. The design of these prototypes is based on the conceptual model by Alexiou and Schippers (2018) linking the instructional design of a serious game to intrinsic motivation, engagement, and learning outcomes. The design of SIGN@L-A will include all elements of the serious game instructional design proposed by these authors which are game mechanics (i.e., objectives to meet, feedback, and rewards), a narrative (i.e., a protagonist, non-playable characters, and narrative events), and aesthetics (i.e., functional and hedonic aesthetics).<br>Other: SIGN@L-B<br>* The design of SIGN@L-B will include only some of these elements which are some of the game mechanics (i.e., objectives to meet, limited feedback), and a functional aesthetic.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Engagement with SIGN@L-A | Measured with the French version of the User Engagement Scale - Short Form (Fontaine et al., 2019; O'Brien et al., 2018). This is a self-reported 5-level Likert -type scale (1 to 5). The overall score varies from 1 to 5 where a higher score is indicative of a greater engagement. | Up to a week after being assigned to SIGN@L-A | 
| Engagement with SIGN@L-B | Measured with the French version of the User Engagement Scale - Short Form (Fontaine et al., 2019; O'Brien et al., 2018). This is a self-reported 5-level Likert -type scale (1 to 5). The overall score varies from 1 to 5 where a higher score is indicative of a greater engagement. | Up to a week after being assigned to SIGN@L-B | 
| Intrinsic motivation toward SIGN@L-A | Measured with the corresponding subscale of the Échelle de motivation situationnelle (Guay et al., 2000). This is a self-reported 7-level Likert-type subscale (1 to 7). The overall score varies from 4 to 28 where a higher score is indicative of a greater intrinsic motivation. | Up to a week after being assigned to SIGN@L-A | 
| Intrinsic motivation toward SIGN@L-B | Measured with the corresponding subscale of the Échelle de motivation situationnelle (Guay et al., 2000). This is a self-reported 7-level Likert-type subscale (1 to 7). The overall score varies from 4 to 28 where a higher score is indicative of a greater intrinsic motivation. | Up to a week after being assigned to SIGN@L-B | 
| Change in clinical reasoning in the context of acute heart failure | Measured with an ad hoc questionnaire. Ten grids are presented to the participant. In each grid, a logical network between two highlighted elements must be developed. Each element refers to a concept related to acute heart failure. Each grid is then rated incorrect (0) or correct (1). The overall score varies from 0 to 10 where a higher score indicates a better clinical reasoning in the context of acute heart failure. | At baseline; up to seven days post-randomization | 
| Change in clinical reasoning in the context of acute heart failure | Measured with an ad hoc questionnaire. Ten grids are presented to the participant. In each grid, a logical network between two highlighted elements must be developed. Each element refers to a concept related to acute heart failure. Each grid is then rated incorrect (0) or correct (1). The overall score varies from 0 to 10 where a higher score indicates a better clinical reasoning in the context of acute heart failure. | At baseline; between seven and fourteen days post-randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time spent playing with SIGN@L-A | Self-reported number of minutes estimated to have been spent playing. | Up to a week after being assigned to SIGN@L-A | 
| Time spent playing with SIGN@L-B | Self-reported number of minutes estimated to have been spent playing. | Up to a week after being assigned to SIGN@L-B | 
| Degree to which the participant would like to play again with SIGN@L-A | Measured with a self-reported 10-point scale (0: not at all; 10; a lot). The score varies from 0 to 10 where a higher score indicates a higher degree to which the participant would like to play again with the serious game. | Up to a week after being assigned to SIGN@L-A | 
| Degree to which the participant would like to play again with SIGN@L-B | Measured with a self-reported 10-point scale (0: not at all; 10; a lot). The score varies from 0 to 10 where a higher score indicates a higher degree to which the participant would like to play again with the serious game. | Up to a week after being assigned to SIGN@L-B | 
| Favorite prototype of the serious game | Participants indicate on a questionnaire which prototype they preferred (SIGN@L-A or SIGN@L-B) | Up to 14 days post-randomization | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Clinical reasoning, Intrinsic motivation, Serious gaming, Nursing education, Undergraduate education