In recent years, serious games have been used as an educational method in various fields such as economy, marketing, military, education, and health as a training method. Pressure injuries (PIs) are a significant health problem and clinical quality improvement issue throughout the world. Implementation of prevention strategies has gained importance in all healthcare settings due to the negative effects of PIs. Educating patient relatives on PI prevention is essential.
Aims
This study aimed to develop a serious game for the training of patient relatives on PI prevention and evaluate the game in terms of knowledge acquisition and its features.
Methods
The study was carried out as a single-group quasi-experimental pre-test and post-test design in three stages between August 1, 2020-April 30, 2022. In the first stage educational content, knowledge assessment test, and game evaluation questionnaire were prepared. A web-based serious game (PreSore: Pressure Injury Prevention Game) was developed in the second stage. The participants played the game in the third stage, and data was collected. The study sample consisted of patient relatives (n=55). A knowledge assessment test (pre-test, post-test, and re-test) and a game evaluation questionnaire were administered for the data collection.
Results
It was determined that there was a significant increase in knowledge scores after the PreSore game implementation (p < .001). Most of the participants indicated that the information in the game was easy to understand (98.2%), they wanted to share their educational experience with others with the digital game method (96.4%), and they found the game was authentic (94.5%).
Conclusions
The study revealed that the PreSore game is a method that could be used to train patient relatives on PI prevention. Integrating the PreSore into daily practice in healthcare institutions and conducting prospective studies are recommended.
AyelloE. A.SibbaldR. G. (2019). Pressure injuries: nursing-sensitive indicator or team-and systems-sensitive indicator?Advances in Skin & Wound Care, 32(5), 199-200. https://doi.org/10.1097/01.ASW.0000557754.10070.88
2.
BayramS. B.CaliskanN. (2019). Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: A randomized controlled trial. Nurse Education Today, 79, 25-31. https://doi.org/10.1016/j.nedt.2019.05.010
3.
BeeckmanD.SchoonhovenL.FletcherJ.FurtadoK.HeymanH.PaquayL.De BacquerD.DefloorT. (2010). Pressure ulcers and incontinence-associated dermatitis: effectiveness of the pressure ulcer classification education tool on classification by nurses. Quality & Safety in Health Care, 19(5), e3. https://doi.org/10.1136/qshc.2008.028415
4.
BoyleE. A.HaineyT.ConnollyT. M.GrayG.EarpJ.OttM.LimT.NinausM.RibeiroC.PereiraJ. (2016). An update to the systematic literature review of empirical evidence of the impacts and outcomes of computer games and serious games. Computers & Education, 94, 178-192. https://doi.org/10.1016/j.compedu.2015.11.003
5.
BredesenI. M.BjøroK.GunningbergL.HofossD. (2016). Effect of e-learning program on risk assessment and pressure ulcer classification-a randomized study. Nurse Education Today, 40, 191-197. https://doi.org/10.1016/j.nedt.2016.03.008
6.
ChaboyerW. P.ThalibL.HarbeckE. L.CoyerF. M.BlotS.BullC. F.NogueiraP. C.LinF. F. (2018). Incidence and prevalence of pressure injuries in adult intensive care patients: A systematic review and meta-analysis. Critical Care Medicine, 46(11), 1074-1081. https://doi.org/10.1097/CCM.0000000000003366
7.
CharlierN.ZupancicN.FieuwsS.DenhaerynckK.ZamanB.MoonsP. (2016). Serious games for improving knowledge and self-management in young people with chronic conditions: a systematic review and meta-analysis. Journal of the American Medical Informatic Association, 23(1), 230-239. https://doi.org/10.1093/jamia/ocv100
8.
DiehlL. A.SouzaR. M.GordanP. A.EstevesR. Z.CoelhoI. C. (2017). InsuOnline, an electronic game for medical education on insulin therapy: a randomized controlled trial with primary care physicians. Journal of Medical Internet Research, 19(3), e72. https://doi.org/10.2196/jmir.6944
9.
EgashiraM.SonD.EmaA. (2022). Serious game for change in behavioral intention toward lifestyle-related diseases: experimental study with structural equation modeling using the theory of planned behavior. JMIR Serious Games, 10(1), e28982. https://doi.org/10.2196/28982
ErdoğanS.NahcivanN.EsinN. M. (2018). Research in nursing: process, practice and critical. 3rd edition, Istanbul: Nobel Medical Bookstores.
12.
European Pressure Ulcer Advisory Panel, National Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. (2019). Prevention and treatment of pressure ulcers/injuries: clinical practice guideline. HaeslerE. (Ed.). EPUAP/NPIAP/PPPIA.
13.
FlemingE.MooreZ.CondellS. (2017). Patient and family/carer experiences of their involvement in a regional quality improvement collaborative utilizing the SSKIN care bundle. International Journal of Integrated Care, 17(5), 197. https://doi.org/10.5334/ijic.3505
14.
FriesgaardK. D.PaltvedC.NikolajsenL. (2017). Acute pain in the emergency department: effect of an educational intervention. Scandinavian Journal of Pain, 15, 8-13. https://doi.org/10.1016/j.sjpain.2016.11.004
15.
GarrisR.AhlersR.DriskellJ. E. (2002). Games, motivation, and learning: a research and practice model. Simulation & Gaming, 33(4), 441-467. https://doi.org/10.1177/1046878102238607
16.
GentryS. V.GauthierA.L'Estrade EhrstromB.WortleyD.LilienthalA.Tudor CarL.Dauwels OkutsuS.NikolaouC. K.ZaryN.CampbellJ.CarJ. (2019). Serious gaming and gamification education in health professions: systematic review. Journal of Medical Internet Research, 21(3), e12994. https://doi.org/10.2196/12994
17.
HaeslerE.PittmanJ.CuddiganJ.LawS.ChangY. Y.BalzerK.BerlowitzD.CarvilleK.KottnerJ.LitchfordM.MooreZ.MitchellP.Sigaudo-RousselD. (2022). An exploration of the perspectives of individuals and their caregivers on pressure ulcer/injury prevention and management to inform the development of a clinical guideline. Journal of Tissue Viability, 31(1), 1–10. https://doi.org/10.1016/j.jtv.2021.10.008
18.
HayranO.ÖzbekH. (2017). Research and statistical methods in health sciences (SPSS expanded with practice examples). 2nd edition, Istanbul: Nobel Medical Bookstores.
19.
JunneF.ZiserK.ManderJ.MartusP.DenzerC.ReinehrT.WabitschM.WiegandS.RennerT.GielK. E.TeufelM.ZipfelS.EhehaltS. (2016). Development and psychometric validation of the ‘Parent Perspective University of Rhode Island Change Assessment-Short' (PURICA-S) Questionnaire for the application in parents of children with overweight and obesity. BMJ Open, 6(11), e012711. https://doi.org/10.1136/bmjopen-2016-012711
20.
KaradağA.ÇakarV. (2022). Evidence-based prevention and management of Pressure Injuries in home care: a scoping review. Advances in Skin & Wound care, 35(3), 172–179. https://doi.org/10.1097/01.ASW.0000815484.50141.5d
21.
KokoreliasK. M.GignacM. A. M.NaglieG.CameronJ. I. (2019). Towards a universal model of family centered care: a scoping review. BMC Health Services Research, 19, 564. https://doi.org/10.1186/s12913-019-4394-5
22.
KrauS. D. (2011). Creating educational objectives for patient education using the new Bloom’s Taxonomy. The Nursing Clinics of North America, 46, 299-312. https://doi.org/10.1016/j.cnur.2011.05.002
23.
KrathJ.SchürmannL.von KorfleschH. F. O. (2021). Revealing the theoretical basis of gamification: a systematic review and analysis of theory in research on gamification, serious games, and game-based learning. Computers in Human Behavior, 125, 106963. https://doi.org/10.1016/j.chb.2021.106963
24.
LiZ.LinF.ThalibL.ChaboyerW. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis. International Journal of Nursing Studies, 105, 103546. https://doi.org/10.1016/j.ijnurstu.2020.103546
25.
LorM.CrooksN.TluczekA. (2016). A proposed model of person, family, and culture-centered nursing care. Nursing Outlook, 64(4), 352-366. https://doi.org/10.1016/j.outlook.2016.02.00
26.
Márquez-HernándezV. V.Gutiérrez-PuertasL.Granados-GámezG.Rodríguez-GarcíaM. C.Gutiérrez-PuertasV.Aguilera-ManriqueG. (2019). Development of a web-based tool to evaluate competences of nursing students through the assessment of their clinical skills. Nurse Education Today, 73, 1-6. https://doi.org/10.1016/j.nedt.2018.11.010
27.
McConnellM. M.MonteiroS.BrysonG. L. (2019). Sample size calculations for educational interventions: principles and methods. Le calcul des tailles d’échantillons pour les interventions éducationnelles: principes et méthodes. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie,66(8), 864-873. https://doi.org/10.1007/s12630-019-01405-9
O'ConnorT.MooreZ. E.PattonD. (2021). Patient and lay carer education for preventing pressure ulceration in at-risk populations. Cochrane Database of Systematic Reviews, 2(2), CD012006. https://doi.org/10.1002/14651858.CD012006.pub2
30.
PokornaA.KlugarM.KelnarovaZ.KlugarovaJ. (2019). Effectiveness and safety of patient centred care compared to usual care for patients with pressure ulcers in inpatient facilities: a rapid review. Journal of the European Wound Management Association, 20(1), 61-70. https://doi.org/10.35279/jewma201905.07
31.
PolitD. E.BeckC. T. (2006). The content validity index: Are you sure you know what’s being reported? critique and recommendations. Research in Nursing & Health, 29(5), 489-497. https://doi.org/10.1002/nur.20147
32.
PourabdollahianB.TaischM.KergaE. (2012). Serious games in manufacturing education: evaluation of learners’ engagement. Procedia Computer Science, 15, 256-265. https://doi.org/10.1016/j.procs.2012.10.077
33.
ProbstS.SeppänenS.GerberV.HopkinsA.RimdeikaR.GethinG. (2014). EWMA document: home care-wound care: overview, challenges and perspectives. Journal of Wound Care, 23 (Suppl 5a), 1-41. https://doi.org/10.12968/jowc.2014.23.Sup5a.S1
34.
RutledgeC.WalshC. M.SwingerN.AuerbachM.CastroD.DewanM.KhattabM.RakeA.Harwayne-GidanskyI.RaymondT. T.MaaT.ChangT. P.Quality Cardiopulmonary Resuscitation (QCPR) leaderboard investigators of the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) (2018). Gamification in action: theoretical and practical considerations for medical educators. Academic Medicine: Journal of the Association of American Medical Colleges, 93(7), 1014-1020. https://doi.org/10.1097/ACM.0000000000002183
35.
SafdariR.GhazisaeidiM.GoodiniA.MirzaeeM.FarziJ. (2016). Electronic game: a key effective technology to promote behavioral change in cancer patients. Journal of Cancer Research and Therapeutics, 12(2), 474-480. https://doi.org/10.4103/0973-1482.154939
36.
SatterfieldH. M. (2015). Technology use in health education: a review and future implications. The Online Journal of Distance Education and e-Learning, 3(2), 87-96.
37.
StepanovicS.MettlerT. (2018). Gamification applied for health promotion: Does it really foster long-term engagement? A scoping review. In Twenty-Sixth European Conference on Information Systems (ECIS2018), Portsmouth, UK, 2018.
38.
StreinerD. L.NormanG. R.CairneyJ. (2015). Health measurement scales: a practical guide to their development and use. USA: Oxford University Press.
39.
TanA. J. Q.LeeC. C. S.LinP. Y.CooperS.LauL. S. T.ChuaW. L.LiawS. Y. (2017). Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: a randomized controlled trial. Nurse Education Today, 55, 38-44. https://doi.org/10.1016/j.nedt.2017.04.027
40.
TubeloR. A.PortellaF. F.GelainM. A.de OliveiraM. M. C.de OliveiraA. E. F.DahmerA.PintoM. E. B. (2019). Serious game is an effective learning method for primary health care education of medical students: A randomized controlled trial. International Journal of Medical Informatics, 130, 103944. https://doi.org/10.1016/j.ijmedinf.2019.08.004
41.
Wound, Ostomy and Continence Nurses Society-Wound Guidelines Task Force. (2017). WOCN 2016 Guideline for Prevention and Management of Pressure Injuries (Ulcers): An Executive Summary. Journal of Wound, Ostomy, and Continence Nursing, 44(3), 241-246. https://doi.org/10.1097/WON.0000000000000321
YaoK.UedoN.MutoM.IshikawaH.CardonaH. J.FilhoE.PittayanonR.OlanoC.YaoF.Parra-BlancoA.HoS. H.AvendanoA. G.PiscoyaA.FedorovE.BialekA. P.MitrakovA.CaroL.GonenC.DolwaniS.FarcaA.TakahashiY. (2016). Development of an e-learning system for the endoscopic diagnosis of early gastric cancer: an international multicenter randomized controlled trial. EBioMedicine, 9, 140-147. https://doi.org/10.1016/j.ebiom.2016.05.016
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