Development of Game-based Simulation Application With 3D Animation Technology for Vital Signs Measurement Skills in Nursing Education

The nursing profession is a discipline that requires competence in both cognitive and psychomotor skills in order to protect and improve the health of individuals and provide appropriate care in cases of illness [1]. In this context, the effective acquisition of psychomotor skills is considered to be one of the fundamental objectives of nursing education [2]. During the education process, students are expected to acquire many skills of varying degrees of difficulty and complexity and become proficient in their application [3]. Among these skills, the accurate assessment, measurement and monitoring of vital signs is one of the important responsibilities of nurses [4].

Any change in vital signs is an early indicator of changes in the patient's overall condition [5, 6]. Therefore, accurate and timely monitoring of vital signs and their effective use in the clinical decision-making process are of great importance for patient safety [7]. However, the relevant literature indicates that vital signs are not regularly and accurately monitored by nurses, and that the quality of monitoring is poor or not reported [8, 9]. So, these omissions in monitoring vital signs lead to an increase in preventable intensive care admissions and mortality rates [10].

Monitoring vital signs, which is critical for effective patient management in clinics, is often left to nursing students with basic knowledge [11]. However, due to the non-invasive nature of vital signs applications, students often perform these applications with minimal or no supervision from a clinical nurse educators or nurses [12]. A review of the literature reveals significant deficiencies in students' knowledge and application of vital signs [11-13]. It is critical that students perform the clinical skills they have acquired correctly and appropriately in order to improve patient safety and quality of care [14, 15]. Considering the importance of monitoring vital signs in a timely and accurate manner for the early identification of clinical deterioration, nursing students must be competent in vital signs assessment [12]. Therefore, it is necessary to use more effective and current learning methods in teaching vital signs.

At this point, the integration of innovative technologies into nursing education enables students to gain experience by repeating these applications without harming the patient and learning from their mistakes [16]. One of these technologies is a virtual game simulation obtained by transferring a real-life situation to the computer platform and gamifying it, which has just begun to be used in nursing education [15]. Recently, virtual gaming simulations have been increasingly used in nursing education to reduce some of the resource challenges of face-to-face simulation [17]. The objective of a virtual gaming simulation is to provide students with the opportunity to apply the concepts they have learned in a realistic scenario [18]. This practice enables students to actively participate in their own learning by its very nature [19]. The utilisation of virtual gaming simulations affords students the opportunity to receive prompt feedback, oversee their performance and conduct objective assessments [20]. Students are afforded the opportunity to repeat the game until they are satisfied with their performance [21]. Therefore, virtual game simulations contribute to the increase of students' academic achievement and skill performance [20]. At the same time, virtual gaming simulation as a teaching strategy enables students to participate in a realistic clinical scenario, reducing their anxiety and supporting their self-confidence [15, 22]. Because simulation offers students the opportunity to develop their nursing knowledge, clinical and psychomotor skills and clinical decision making levels in a simulated safe environment and over a long period of time before encountering real patients [17].

When reviewing the literature on nursing education, no research findings were found regarding the use of game-based virtual reality simulation applications for measurement skills related to vital signs. In this study, a game-based simulation application developed using 3D animation technology was designed to fill this gap and to enable nursing students to acquire vital signs measurement skills. We aimed to evaluate the effects of this application on students' academic achievement, satisfaction and self-confidence in learning. In this way, the aim is to provide an effective and technology-based teaching strategy that will increase patient safety in nursing education.