A gameful blended-learning experience in nursing: A qualitative focus group study

Background: The COVID-19 pandemic has posed significant challenges around the world, affecting over 1.5 billion students in 191 countries. This situation has forced faculties and health-related degrees in particular to be innovative, flexible, and agile when transitioning to online or blended learning. Objective: The aim of this study was to explore nursing students' experiences and perceptions of the use of game elements in two full-nursing subjects using a blended-learning teaching strategy. Design: A qualitative study was conducted through sixteen focus group interviews between November 2020 and January 2021. Setting: This study took place at the Jaume I University with students enrolled in Adult and Elderly Health Programmes and Chronic Processes in their second and third year, respectively. Participants: One hundred forty-nine second- and third-year undergraduate nursing students took part in the focus group interviews. Methods: A blended-learning teaching approach with game elements was developed for two full-undergraduate nursing subjects. Focus groups using a semi-structured interview protocol were conducted after delivering the teaching content. A content analysis was used to analyse the focus group interview data. Results: The qualitative analysis revealed four major themes: (i) teaching transition in the COVID-19 pandemic scenario, (ii) game elements to retain student attention and learning, (iii) gameful designs for competency-based team training, and (iv) blended learning vs face-to-face learning including gamification. Conclusions: This study yields, for the first time, findings about the use of game elements in blended learning. This strategy was shown to be useful for teaching other key clinical or teamwork-related skills such as creativity, innovation, team-based communication, and responsibility, in addition to supporting the use of this innovative teaching strategy to reduce online fatigue and stress and increase student engagement in online classes.