It can be difficult to understand the process of making decisions in health care, because of both the complexity of health care systems and the demands faced by health care professionals. Serious games offer an underexplored opportunity to elicit data about decision-making. In this article, we present and reflect on a methodological case study where we used a serious game as part of a semistructured interview to study the process of decision-making. The game Resilience Challenge presented a patient's journey through a hospital, where a player had to make decisions that influenced patient care. The game was used during interviews with 20 nurses, both in person and remotely. Having a mini debrief with a participant after each game scenario provides to be a helpful technique to understand the participants' decision-making process and elicit tacit knowledge about their work. Serious games show promise as a methodological research tool to elicit the process of decision-making among health care professionals.
Get full access to this article
View all access options for this article.
References
1.
ConnollyTM, BoyleEA, MacArthurE, et al.A systematic literature review of empirical evidence on computer games and serious games. Comput Educ, 2012; 59:661–686.
2.
RicciardiF, De PaolisLT. A comprehensive review of serious games in health professions. Int J Comput Games Technol, 2014; 9:1–11.
3.
SipiyarukK, GallagherJE, HatzipanagosS, et al.A rapid review of serious games: From healthcare education to dental education. Eur J Dent Educ, 2018; 22:243–257.
4.
WangR, DeMariaSJr, GoldbergA, et al.A systematic review of serious games in training health care professionals. Simul Healthc, 2016; 11:41–51.
5.
ParkYM, KimSY. Impacts of job stress and cognitive failure on patient safety incidents among hospital nurses. Saf Health Work, 2013; 4:210–215.
6.
GregoryPA, WhyteB, AustinZ. How do community pharmacists make decisions? Results of an exploratory qualitative study in Ontario. Can Pharm J (Ott), 2016; 149:90–98.
7.
FedoJ. Nurses' decision making and pain management outcomes. Doctor ofPhilosophy thesis, University ofConnecticut, 2014. https://opencommons.uconn.edu/dissertations/321/ (accessed August1, 2021).
8.
JohansenML, O'BrienJL. Decision making in nursing practice: A concept analysis. Nurs Forum, 2016; 51:41–48.
9.
JacksonJ, AndersonJE, MabenJ. What is nursing work? A meta-narrative review and integrated framework. Int J Nurs Stud, 2021; 122:103944.
10.
Lundgrén-LaineH, KontioE, Perttilä J, et al. Managing daily intensive care activities: An observational study concerning ad hoc decision making of charge nurses and intensivists. Crit Care, 2011; 15:R188.
11.
SiiralaE, PeltonenLM, Lundgren-LaineH, et al.Nurse managers' decision-making in daily unit operation in peri-operative settings: A cross-sectional descriptive study. J Nurs Manag, 2016; 24:806–815.
12.
BarnardR, JonesJ, CruiceM. When interactions are interruptions: An ethnographic study of information-sharing by speech and language therapists and nurses on stroke units. Disabil Rehab, 2021; 1–11. DOI 10.1080/09638288.2021.1871785
13.
ReddingDA, RobinsonS. Interruptions and geographic challenges to nurses' cognitive workload. J Nurs Care Qual, 2009; 24:194–200; quiz 201–192.
14.
AitkenLM, MarshallA, ElliottR, et al.Comparison of ‘think aloud’ and observation as data collection methods in the study of decision making regarding sedation in intensive care patients. Int J Nurs Stud, 2011; 48:318–325.
15.
RavenME, FlandersA. Using contextual inquiry to learn about your audiences. ACM SIGDOC Asterisk J Comput Document, 1996; 20:1–13.
16.
Van GraaCA, Williams, KoenM.Pj. Professional nurses' understanding of clinical judgement: A contextual inquiry. Health SA Gesondheid, 2016; 21:280–293.
17.
SavageJ. Ethnographic evidence: The value of applied ethnography in healthcare. Nurs Res, 2006; 11:383–393.
18.
SavageJ. Ethnography and health care. BMJ, 2000; 321:1400–1402.
19.
HusebøSE, O'ReganS, NestelD.Reflective practice and its role in simulation. Clin Simulat Nurs, 2015; 11:368–375.
20.
Egenfeldt-NielsenS, SmithJH, ToscaSP. Understanding Video Games: The Essential Introduction (4th ed.). New York,NY: Routledge; 2019.
21.
ArnabS, DunwellI, Debattista K (eds.). Serious Games for Healthcare: Applications and Implications. London, UK: IGI Global; 2012.
KhaledR. Questions over answers: Reflective game design. In: Cermak-Sessenrath D (ed.). Playful Disruption of Digital Media. Berlin/Heidelberg: Springer; 2018, pp. 3–27.
24.
MeklerED, IacovidesI, BoppJA. “A game that makes you question…”: Exploring the role of reflection for the player experience. CHI PLAY ‘18: Proceedings of the 2018 Annual Symposium on Computer-Human Interaction in Play, 2018, pp. 315–327.
25.
IacovidesI, CoxAL. Moving beyond fun: evaluating serious experience in digital games. CHI ‘15: Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems, 2015, pp. 2245–2254.
JacksonJ, IacovidesJ, DuncanM, et al.Operationalizing resilient healthcare concepts through a serious video game for clinicians. Applied Ergonomics, 2020; 87:103112. https://doi.org/https://doi.org/10.1016/j.apergo.2020.103112.
28.
IacovidesI, CoxAL, FurnissD, et al.Supporting engagement in research through a game design competition. Res All, 2019; 3:25–41.
29.
HannigA, KuthN, OzmanM, et al.eMedOffice: A web-based collaborative serious game for teaching optimal design of a medical practice. BMC Med Educ, 2012; 12:104.
30.
GuiseV, ChambersM, ConradiE, et al.Development, implementation and initial evaluation of narrative virtual patients for use in vocational mental health nurse training. Nurse Educ Today, 2012; 32:683–689.
31.
GuiseV, ChambersM, ValimakiM. What can virtual patient simulation offer mental health nursing education?. J Psychiatr Ment Health Nurs, 2012; 19:410–418.
32.
AdamsA, HartJ, IacovidesI, et al.Co-created evaluation: Identifying how games support police learning. Int J Hum Comput Stud, 2019; 132:34–44.
HerbigB, BussingA, EwertT. The role of tacit knowledge in the work context of nursing. J Adv Nurs, 2001; 34:687–695.
35.
AndersonJE, RossAJ, BackJ, et al.Implementing resilience engineering for healthcare quality improvement using the CARE model: A feasibility study protocol. Pilot Feasibility Stud, 2016; 2:61–70.
36.
AndersonJE, RossAJ, MacraeC. Defining adaptive capacity in healthcare: A new framework for researching resilient performance. Appl Ergonom, 2020; 87:103111.
37.
HamiltonRJ. Using skype to conduct interviews for psychosocial research. Comput Inform Nurs, 2014; 32:353–358.
38.
IaconoVL, SymondsP, BrownDH. Skype as a tool for qualitative research interviews. Sociol Res Online, 2016; 21:1–15.
39.
OatesJ. Use of Skype in interviews: The impact of the medium in a study of mental health nurses. Nurse Res, 2015; 22:13–17.
40.
FonteynME, KuipersB, GrobeSJ. A description of think aloud method and protocol analysis. Qual Health Res, 1993; 3:430–441.
41.
Lundgren-LaineH, SalanteraS. Think-aloud technique and protocol analysis in clinical decision-making research. Qual Health Res, 2010; 20:565–575.
ThorneS. Interpretive Description. Walnut Creek, CA: Left Coast Press, Inc.; 2008.
44.
van BraakM, de GrootE, VeenM, et al.Eliciting tacit knowledge: The potential of a reflective approach to video-stimulated interviewing. Perspect Med Educ, 2018; 7:386–393.
