title: Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game.
abstract: Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care.
  
  
  
  This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings.
  
  
  
  A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Bloom's taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics.
  
  
  
  The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user-computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings.
  
  
  
  Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user-computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process.
authors: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway. Electronic address: hege.mari.johnsen@uia.no.
authors: Hege Mari
authors: HM
authors: Johnsen
authors: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
authors: Mariann
authors: M
authors: Fossum
authors: Medical Education, The Medical School, University of Sheffield, UK.
authors: Pirashanthie
authors: P
authors: Vivekananda-Schmidt
authors: College of Information Science and Technology, University of Nebraska, Omaha, USA.
authors: Ann
authors: A
authors: Fruhling
authors: Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
authors: Åshild
authors: Å
authors: Slettebø
mesh_terms: D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003479:Curriculum; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D007858:Learning; D009042:Motivation; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000451:nursing*; D013338:Students, Nursing / Q000523:psychology*; D013663:Teaching; D014584:User-Computer Interface; D018910:Video Games
keywords: Clinical decision-making; Community health nursing; Computer simulation; Education; Problem-based learning; User-computer interface