The impact of feedback elements in serious games on nursing learning outcomes: A systematic review and meta-analysis.

OBJECTIVE

This study evaluates the impact of different feedback elements in serious games (SGs) on nursing education outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

6546 English-language studies published between 2000 and 2023 were retrieved from seven electronic databases.

REVIEW METHODS

This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis and subgroup analysis were conducted using RevMan 5.4, and the certainty of evidence for each outcome was assessed using the GRADE approach.

RESULTS

Eight studies were included in the meta-analysis. Findings showed that, compared to traditional learning methods, outcome feedback had a moderate effect size on knowledge (SMD = 0.51, 95 % CI [0.09, 0.92]), while comparative feedback had a small, non-significant effect size (SMD = 0.38, 95 % CI [-0.36, 1.12]). Immediate feedback had a large effect size on skills (SMD = 0.87, 95 % CI [0.61, 1.14]), and outcome feedback had a moderate effect size (SMD = 0.50, 95 % CI [0.21, 0.79]). Serious games with feedback had a large effect size on motivation (SMD = 1.31, 95 % CI [0.45, 2.17]). For confidence, outcome feedback had a moderately large effect size (SMD = 0.64, 95 % CI [-0.22, 1.51]), and comparative feedback had a small effect size (SMD = 0.24, 95 % CI [-0.44, 0.91]), but neither reached statistical significance. GRADE assessment showed high certainty for immediate feedback on skills, moderate certainty for outcome feedback on knowledge and skills, and very low certainty for comparative feedback on knowledge. Evidence certainty for motivation and confidence was low or very low.

CONCLUSION

Serious games incorporating feedback elements can enhance nursing students' motivation. Immediate feedback significantly improves nursing skills, while outcome feedback improves knowledge acquisition. However, further research is needed to validate these findings due to the limited number of studies and high heterogeneity.