Possible benefits of gamification for improving surgical patients' quality of care

´This paper considers the potential benefits of gamification from the perspective of surgical patients' quality of care. There is little published data on gamifying the work of healthcare professionals even though the use of serious games in healthcare has been growing. Literature on the quality of care shows that patients are often satisfied with the care they have received. However, research indicates that deficiencies exist in patient education, in patients' opportunities to participate in and have impact on decision making regarding their care, and in prevention and management of complications. Workplace culture is significantly connected with the incidence of patient complications. Gamification of healthcare workers' daily work routines could have positive effects on nurses' ownership and the meaningfulness of their work, and on the prevention and management of complications, which would in turn improve the quality of care for surgical patients. In this paper, a hypothetical gamification case is presented and directions for future research are discussed.Peer reviewe

Serious gaming and gamification education in health professions: Systematic review

Background: There is a worldwide shortage of health workers, and this issue requires innovative education solutions. Serious gaming and gamification education have the potential to provide a quality, cost-effective, novel approach that is flexible, portable, and enjoyable and allow interaction with tutors and peers. Objective: The aim of this systematic review was to evaluate the effectiveness of serious gaming/gamification for health professions education compared with traditional learning, other types of digital education, or other serious gaming/gamification interventions in terms of patient outcomes, knowledge, skills, professional attitudes, and satisfaction (primary outcomes) as well as economic outcomes of education and adverse events (secondary outcomes). Methods: A comprehensive search of MEDLINE, EMBASE, Web of Knowledge, Educational Resources Information Centre, Cochrane Central Register of Controlled Trials, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to August 2017. Randomized controlled trials (RCTs) and cluster RCTs were eligible for inclusion. Two reviewers independently searched, screened, and assessed the study quality and extracted data. A meta-analysis was not deemed appropriate due to the heterogeneity of populations, interventions, comparisons, and outcomes. Therefore, a narrative synthesis is presented. Results: A total of 27 RCTs and 3 cluster RCTs with 3634 participants were included. Two studies evaluated gamification interventions, and the remaining evaluated serious gaming interventions. One study reported a small statistically significant difference between serious gaming and digital education of primary care physicians in the time to control blood pressure in a subgroup of their patients already taking antihypertensive medications. There was evidence of a moderate-to-large magnitude of effect from five studies evaluating individually delivered interventions for objectively measured knowledge compared with traditional learning. There was also evidence of a small-to-large magnitude of effect from 10 studies for improved skills compared with traditional learning. Two and four studies suggested equivalence between interventions and controls for knowledge and skills, respectively. Evidence suggested that serious gaming was at least as effective as other digital education modalities for these outcomes. There was insufficient evidence to conclude whether one type of serious gaming/gamification intervention is more effective than any other. There was limited evidence for the effects of serious gaming/gamification on professional attitudes. Serious gaming/gamification may improve satisfaction, but the evidence was limited. Evidence was of low or very low quality for all outcomes. Quality of evidence was downgraded due to the imprecision, inconsistency, and limitations of the study. Conclusions: Serious gaming/gamification appears to be at least as effective as controls, and in many studies, more effective for improving knowledge, skills, and satisfaction. However, the available evidence is mostly of low quality and calls for further rigorous, theory-driven research

Healthy Competition: Multiplayer Digital Games in Health Education

The focus of this dissertation is on the role of multiplayer digital games in adult education, with a particular emphasis on health education. Although interest in the use of digital games for serious applications has been increasing since the early 2000s, there is a significant gap in understanding on the use of multiplayer digital games in adult education. In the context of health education, there has been a large amount of research conducted in to the use of repurposed commercial games for predicting performance of trainees and health students on surgical simulators. However, beyond this niche research into game based learning is notably less cohesive. There has been some research into the use of digital games in areas such as for delivering insulin management training, but understanding of the processes for widespread application of games based learning in the health sector is limited. Additionally, almost no research has been undertaken into the use of multiplayer digital games in health education, whether it be for tertiary or adult learners. In this dissertation two digital games were developed, implemented and evaluated to explore the value of multiplayer games for supporting cooperation and collaboration in health education. The first game, They Know: Anatomy, was a real time team based strategy game designed to support anatomy revision by second year medical students. The second game, the Qstream: Cancer Cup Challenge, was a team based asynchronous online program designed to reinforce understanding of how to identify and manage adverse events by oncology registrars. A design research framework informed the methodology used in this dissertation. This framework emphasises the need to use multiple iteration cycles to develop a comprehensive understanding of player experiences with the digital games they encountered. Data on participant experiences with the digital games was collected using qualitative methods, including post-game surveys and semi-structured interviews. Between iterative cycles data on participant experiences with the digital games were analysed so that future implementations of the game could be modified to maximise cooperation and collaboration between players. At the conclusion of the study period data collected across all implementations of the digital games were analysed to increase understanding of how multiplayer digital games supported cooperation and collaboration between learners. Findings from this dissertation demonstrate that multiplayer digital games can be used to engage medical students in anatomy revision and medical oncologists in adverse events retraining. This is the first study to look at the use of digital games for either of these demographics. Additionally, this dissertation identified four ways through which multiplayer digital games foster collaboration between players: through the development of a team strategy to win the game, by facilitating !iii shared decision making, by working towards a shared goal, and by creating a sense of investment in a team. Finally, findings from this dissertation contribute to the literature on the implementation of game based learning in adult education. This is an under researched area, but one that warrants further focus in future if game based learning is going to be successfully incorporated into curricula and training activities for adult learners. This dissertation adds to the literature by presenting new knowledge on how and why multiplayer games support collaboration between learners. Additionally, it appears that multiplayer digital games offer diverse, flexible and immersive experiences to adult learners in a way that single player digital games may not. Finally, multiplayer digital games provide new avenues for support self-directed learning by encouraging cooperation between large groups of students in a manner that is not normally achieved in online learning environment

Development and implementation of a remote monitoring and coaching intervention delivered using digital health technology for people with a history of cancer.

There is a need to improve care practices to optimally enhance physical health and health- related quality of life in people with a history of cancer. Intensive treatment of cancer can impact patients both acutely and chronically as long-term or late effects well after treatment completion. As a result, both patients with cancer and cancer survivors need additional support Supportive cancer care, including survivorship and rehabilitation services focuses on developing strategies to support survivors’ well-being and recovery during and after cancer treatment. However, despite the evidence-based benefits of these services, many barriers still exist that may restrict patients with cancer from participation and engagement. One possible solution to these challenges is the use of digital health technologies. The aim of this research was to explore current gaps in knowledge regarding digital health enabled supportive cancer care and design and develop a digital health enabled intervention, specifically tailored to the needs of people with a cancer diagnosis. The experience culminated in the implementation of a 10-week prospective cohort trial, focused on the feasibility and acceptability of a patient-provider tracking and exercise coaching portal. As evidenced by the research studies presented within this thesis, findings suggest that patient-centric supportive care can be provided to cancer patients using a digital health enabled approach. Further, remote monitoring and individual exercise coaching can feasibly be offered to patient populations who may not be able to conveniently access support services, or who choose to access these services remotely. Several recommendations for future research and future directions were provided to further this area of research

A Comparison of Registered Nurses’ Motivation and Knowledge Levels Between Gamified And Traditional Courses

Registered nurses (RNs) working in today’s healthcare environment must consistently learn new knowledge and skills, keep abreast of practice changes, and implement strategies to improve patient outcomes. However, healthcare organizations face significant challenges as they attempt to facilitate efficient training. Nursing professional development practitioners miss opportunities to leverage learner motivation, which drives investment, knowledge retention, and practice application. Gamification, which strategically embeds game elements and mechanics into an educational design to boost motivation, offers a potential solution. It aims to increase learner engagement by presenting learners with challenges, tracking their progress, and offering feedback, ultimately leading to knowledge retention and application. The purpose of this quantitative study was to examine whether gamification leads to increases in motivation to learn and knowledge levels for RNs. Specifically, the study focused on RNs who did not have previous cardiac monitoring experience. The study used flow theory and self-determination theory to optimally incorporate gamification. A quasi-experimental posttest-only design with a comparison group allowed for comparisons among RNs who completed a traditional ECG course with those who completed a gamified ECG course. The comparison group contained 66 eligible participants who completed the survey and the experimental group contained 64 participants. Post-course surveys were electronically distributed to registered nurses who completed either the traditional or the gamified version of the ECG course. Research instruments included a demographic survey, the Flow Perceptions Questionnaire (a self-reporting motivational survey), and an ECG knowledge test. Additionally, RNs who completed the gamified version were administered a short survey measuring the motivational effects of included game elements and mechanics. Two hierarchical multiple regressions were conducted to identify differences between the comparison and experimental groups when controlling for age and current patient care environment. The first indicated the addition of the variable class type to the prediction of ECG test scores was statistically significant (ΔR2 = .116, p \u3c.001). Therefore, the experimental group scored statistically significantly higher than the comparison group. The second hierarchical multiple regression suggested the addition of the variable class type to the prediction of Flow Perceptions Questionnaire scores was not statistically significant (ΔR2 = .006, p = .397). Thus, no significant differences were discovered between the two groups specific to learner motivation. In fact, the comparison group reported higher motivation levels than the experimental group. The proposed theoretical framework effectively guided the ECG course’s gamification design; however, since anticipated learner motivation scores were not achieved, minor adjustments might be warranted. Game mechanics and game elements, specifically selected for the gamified ECG course based on learner personas, were mostly rated as promoting higher motivation levels. Future research must be conducted to improve sample diversity, control, and motivation measurement, in addition to exploring qualitative data, longitudinal outcomes, and gamification’s various technological sophistication levels

CAN YOU TALK YOUR WAY OUT OF THIS? AN EDUCATIONAL ESCAPE ROOM

Despite being a top healthcare priority, patient safety remains a problem in the U.S. with hundreds of thousands of annual patient deaths due to medical errors. Communication breakdowns within the healthcare team are a key factor in poor patient outcomes and in relatively low retention rates among healthcare professionals, especially nurses. To prepare nursing students for a successful entry into the profession, nurse educators must consider alternate strategies for teaching communication skills to a new generation of students. This qualitative study explored the use of a game-based escape room as part of a multi-part communication lesson plan and its impact on student perceptions of the value of communication in healthcare. The data for the current study was collected from a small sample of nursing students representing multiple generations at a Midwestern community college. The study found that the educational escape room raised awareness among nursing students of the importance of communication to a healthcare team. It also highlighted the greater affinity of younger students for immersive game approaches in education. These findings indicate the need and opportunity of including non-traditional teaching methods in nursing curriculum tailored for the unique learning profiles of a new generation of nursing students

The influences of gamification on user experience in the healthcare sector

Abstract. Gamification is a considerably emerging trend focusing on the application of game mechanics to a nongame context. The objective of gamification implication in serious settings is to form the positive outcomes from the patients. While education and business have been taken advantages of gamification, the digital health domain just started the journey with this prevailing trend. That is why, there is an increasing demand for scientific research on the gamification in healthcare, especially the user experience under the gamified healthcare solution from the company perspective. With this inspiration, the study is conducted aiming at exploring the user experience under the impact of gamification in the healthcare context. Study indicates that it is the affordances, which are also known as game elements that stimulate various psychological and behavioural experience for the users. The combination of the achievement-oriented, social-oriented and immersion-oriented affordances in the gamified healthcare solution triggers the various psychological and behavioural experience. These experiences are examined under three perspectives which are stimulation, interaction and sense-making. Through the stimulation lens, the psychological experiences are favourably formed and dominant the behavioural experience. While, the interaction lens indicates the dominance of the behavioural experience, especially the performance-related outcomes. The sense-making view shows the actor-related behavioural experience outweighs of the other outcomes. The exploratory qualitative research and the semi-structured interviews are utilised to investigate the game affordances in the gamified solutions and the user experience from the gamified solution providers angles. The study expectedly contributes to the literature’ body of gamification by confirming the conceptualisation of the gamification and the formation of the user experience. The empirical implications are for the gamified healthcare solution design regarding the affordance combination and the utilisation of the insights from both patients and game players

Serious Gaming and Gamification interventions for health professional education

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of Serious Gaming and Gamification interventions for delivering pre- and post-registration health professional education compared with traditional learning, other types of eLearning, or other Serious Gaming and Gamification interventions. We will primarily assess the impact of these interventions on students' knowledge, skills, professional attitudes and satisfaction