title: Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.
abstract: BACKGROUND
  Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning.
  
  
  OBJECTIVE
  To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game.
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process.
  
  
  METHODS
  Nursing students from the surgical nursing course of autumn 2014 (N=166).
  
  
  METHODS
  Data were collected by means of an online questionnaire.
  
  
  RESULTS
  In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all.
  
  
  CONCLUSIONS
  Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process.
authors.affiliation: Faculty of Behavioural Sciences, University of Helsinki, P.O. Box 9, FI-00014 Helsinki, Finland. Electronic address: jaana-maija.koivisto@helsinki.fi.
authors.forename: Jaana-Maija
authors.initials: JM
authors.lastname: Koivisto
authors.affiliation: Tampere University of Technology, Pohjoisranta 11 A, FI-28100 Pori, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Multisilta
authors.affiliation: Faculty of Behavioural Sciences, University of Helsinki, P.O. Box 9, FI-00014 Helsinki, Finland.
authors.forename: Hannele
authors.initials: H
authors.lastname: Niemi
authors.affiliation: Department of Mathematics and Statistics, University of Turku, 20014 Turku, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Katajisto
authors.affiliation: Department of Nursing Science, University of Turku, 20014 Turku, Finland.
authors.forename: Elina
authors.initials: E
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D019359:Knowledge; D007858:Learning; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D000066908:Simulation Training / Q000379:methods; D013338:Students, Nursing / Q000523:psychology*; D013850:Thinking; D014584:User-Computer Interface; D018910:Video Games; D055815:Young Adult
keywords: 3D simulation game; Clinical reasoning; Game mechanics; Learning; Nursing students; Playing