In the fast-paced and critical environment of healthcare, nurses are constantly required to make complex decisions, analyze situations, and adapt their actions based on patient outcomes. The ability to do this effectively hinges on a crucial competency: reflective thinking. This higher-order thinking skill allows nurses to evaluate their experiences, learn from them, and ultimately provide better patient care. Recognizing its importance, nursing education programs are actively seeking innovative teaching methods that move beyond traditional information transfer and empower students to become active, self-evaluating learners.
A recent study by Ayşegül Açıl and Ayla Keçeci, published in BMC Nursing, explores a promising educational tool: simulation games. Their mixed-methods study, titled “Effect of a simulation game on nursing students’ reflective thinking skills,” investigates how a specific game called “The Ward” can significantly improve this essential skill in senior nursing students. This article provides valuable insights for nurse educators, curriculum developers, and healthcare administrators looking to better prepare the next generation of nurses for the complexities of clinical practice.
Study Design and Methodology
The research was conducted at a university in Türkiye between February and April 2018 with a group of 23 senior nursing students. The authors employed a convergent parallel mixed-methods design, a robust approach that collects and analyzes both quantitative (numerical) and qualitative (descriptive) data simultaneously to provide a more comprehensive understanding of the topic.
- Quantitative Approach: A single-group, quasi-experimental design was used. The students’ reflective thinking levels were measured before and after the intervention using the Reflective Thinking Scale. This 16-item, five-point Likert scale assesses four key dimensions of reflection:
- Habitual Action: Performing tasks automatically without conscious thought.
- Understanding: Using existing knowledge to comprehend a situation.
- Reflection: Evaluating an experience to create new meaning and perspectives.
- Critical Reflection: The highest level, involving changes in one’s core beliefs and values based on experience.
- Qualitative Approach: To capture the students’ lived experiences, the researchers used a phenomenological approach. Data was gathered through:
- Focus group interviews (debriefings) held after each game session. These were guided by Gibbs’ Reflective Cycle, a structured model for reflection.
- Two-column writings, where students documented their experiences and their reflections on those experiences.
- Inductive content analysis was used to identify key themes from the transcribed debriefings and writings.
The intervention involved students playing “The Ward,” a simulation game developed by David Stanley, once a week for seven weeks. In the game, students take on various roles like “Ward manager” and “Clinical nurse” and work in teams to manage scenarios related to patient care, budget, staff morale, and leadership.
Key Findings
The results of the study were compelling and demonstrated the powerful impact of the simulation game on students’ reflective abilities.
Quantitative Results: The study found a statistically significant increase in students’ overall reflective thinking scores after the seven-week intervention. The mean pre-test score was 39.70, which rose to 67.39 on the post-test. Significant improvements were observed across all four subdimensions of the scale, with the most substantial gains in “reflection” and “critical reflection”. This indicates that the game didn’t just help students understand concepts but actively pushed them to evaluate and change their perspectives.
Qualitative Results: The qualitative data from debriefings and writings richly supported the quantitative findings. Several major themes emerged:
- Teamwork and Collaboration as a Catalyst: This was the most prominent theme. Students reported that the collaborative environment of the game created a democratic and safe space where they could freely share ideas, challenge each other’s perspectives, and work towards a common goal. One student noted, “teamwork enables us to look at different ways, we can evaluate each other from different perspectives, criticize and realize the best points in this way”.
- Awareness of Knowledge Gaps: The game environment allowed students to identify their own “shortcomings and mis-learnings”. By comparing their knowledge with that of their peers in a practical context, they became aware of areas needing improvement, which is a foundational step in reflective practice.
- Professional and Personal Development: Students overwhelmingly felt the experience contributed to their professional development. The game enhanced their confidence, expanded their perspectives, and improved their decision-making skills. As one participant stated, “This game increased our ability to cope with different situations that we may face in real life as well as our responsibilities for patient care”. The experience was also described as “learning with fun,” which increased student motivation and engagement.
Conclusion and Implications
This study by Açıl and Keçeci provides strong evidence that simulation games like “The Ward” are effective tools for developing reflective thinking skills in nursing students. The research highlights that the teamwork and collaborative problem-solving inherent in the game are key drivers of this development. By creating a safe, engaging, and realistic learning environment, simulation games bridge the gap between theoretical knowledge and clinical practice.
The authors conclude with a clear call to action for the nursing profession. They argue that nursing education curricula need to be restructured to integrate innovative methods like simulation games. Nurse educators and policymakers should work together to ensure that graduates possess these essential higher-order thinking skills. Furthermore, the use of simulation should be encouraged in ongoing professional development and in-service training for practicing nurses to promote lifelong learning and continuous improvement in patient care.
For anyone involved in nursing education or healthcare leadership, this study is a must-read. It not only validates the use of an innovative teaching strategy but also provides a practical framework for how to foster the critical skill of reflection in the nurses of today and tomorrow.
APA Reference: Açıl, A., & Keçeci, A. (2024). Effect of a simulation game on nursing students’ reflective thinking skills: a mixed methods study. BMC Nursing, 23(1), 704. https://doi.org/10.1186/s12912-024-02228-w