1. Masters, Kathleen DNS, RN

Article Content

Traditional teaching strategies typically include lecture, class discussion, and the use of overhead projector transparencies or PowerPoint slide shows. While these strategies can be effective in transferring knowledge,1 when used alone, these strategies can become boring to students. Including an alternate teaching strategy such as gaming can make learning fun.2


Games are not only fun but also, as cited in the literature, an effective teaching strategy.1 The use of games as a teaching strategy encourages involvement3 and increases both the motivation and the interest of the student.2 Games can promote the development of critical thinking4 and challenge students to apply knowledge.5 Games also give students the opportunity to share their knowledge with peers3 and allows for the review of a large amount of information in a short time.2 According to Sprengel,6 evaluation, discussion, reflection, and application occur during gaming, all of which promote learning.


There can also be disadvantages in the use of games as a teaching strategy. The development of a game that coincides with course objectives and essential content typically takes more time to prepare than that taken preparing for a lecture or planning for class discussion. Use of a game also involves the use of class or clinical conference time that might have been used for lecture or discussion,4 making it important to decide in advance how much time can be allowed for implementation of a game.


Traditionally, the types of games used in nursing education have included those based on popular board games, those based on television or game shows, and those created by educators.7 The game presented in this report is an educator-developed board game.


Game Development

The ultimate goal of the game was for students to apply knowledge and practice skills necessary for performing a community assessment. Learning objectives were based on course objectives and essential content. Learning objectives included the following:


1. Students will recall content so as to correctly answer game questions related to community assessment concepts.


2. Students will formulate an applicable community health diagnosis based on data collected during the game.


3. Students will evaluate the appropriateness of the community health diagnosis in relation to the data collected during the game.



A game board, game cards, and game pieces had to be created. The 2-dimensional game board was created from black foam board with draw data card and draw question card spaces forming a road curving through the community. The community was formed with colorful squares of various sizes that represented buildings, blue paper forms for water, and green paper forms for trees. The game pieces included a die and miniature cars since the windshield tour of the community is a component of the community assessment process.


Finally, data cards and question cards were made and laminated for the draw piles. Question cards included questions such as "name 1 method of data collection for community assessment," "name 1 of the nonhealth systems that you will need to assess during the community assessment process," and "name a community assessment framework or model." Data cards included both subjective and objective data. Data included fictitious interviews with community leaders and residents and observations of resident behavior related to diet and exercise. For example, 1 card recorded information from an interview with the police chief and another card recorded information from an interview with a long-time resident of the community related to changes that had taken place in the community over time.


Data also included observations related to the environment of the community. Local, state, and national demographic data, health status indicator data, morbidity data, and mortality data were also included in the data cards. For example, the data on 1 card provided information related to the teen birth rate per 1000 for the community, the state, and the nation. Another card provided data on immunization rates by race for the community, the state, and the nation.


The next step in developing the game was to determine the object of the game in terms of how to win the game and instructions or rules for the game. The larger groups were divided into teams and a team representative rolled the die to see which team would take the first turn. The team whose representative rolled the highest number began first. The team representative then rolled the die to see how many spaces the team could advance on the game board.


When a team landed on a "draw question card" space, the team answered the question from the question card draw pile. If the question was answered correctly, the team could draw a data card. If the team could not answer the question correctly, it did not draw a data card. When a team landed on a "draw data card" space, the team could draw a data card without answering a question.


To win the game, a team had to advance to the intervention and evaluation space on the board and had to develop a community health diagnosis based on the subjective and objective data it had collected as it traveled around the game board. To advance to the intervention and evaluation space, the diagnosis had to be stated in the correct format and the other teams had to agree that the diagnosis was reasonable based on the data collected. If the other teams voted that the diagnosis was not reasonable and were able to provide reasonable rationale for a negative vote, then the team whose diagnosis was rejected had to roll the die and move backwards the number of spaces indicated on the die. Beginning with its next turn, it could again move forward.



The students played the game during postconference in the clinical portion of a baccalaureate community health nursing course after the community assessment content was presented in the classroom setting but prior to the examination on that content. The game was played during the clinical postconference since the community assessment assignment was completed during the clinical component of the course. This gave the students a safe environment to practice some of the skills required for the assignment as well as time to review the course content necessary for completion of the assignment. There were 2 separate postconference sessions in which the game was played with a total of 21 students. Eleven students were in the first session, and 10 students were in the second session.



The game was definitely a success. Students had fun as evidenced by laughter, smiling faces, and body language that showed enthusiasm. Students verbally commented that the game "really was a lot of fun" and insisted that the faculty member "tell others about the game" through publication. Apart from having fun during the game, student groups seriously considered the data collected before proposing a community health diagnosis and fairly evaluated the diagnoses proposed by other groups for applicability based upon the data collected during the game.



The use of games in nursing education is supported in the nursing literature as an effective teaching strategy. One of the nice things about using games as a teaching strategy is that games can easily be adapted. For example, the basic idea of the community assessment game could be easily adapted to use with students learning pathophysiology or physical assessment skills. The game board could be made in the form of a human body. The game board could reflect the outside of the body for physical assessment purposes or reflect the internal systems of the body for pathophysiology content. The question cards could have questions related to physical assessment or pathophysiology course content, and the data cards could have signs and symptoms, laboratory values, and patient interview data, with an ultimate goal of identifying patient problems, nursing diagnoses, and planning appropriate nursing interventions. There are countless possibilities for the use of games in nursing education. Games make learning fun for students and for teachers.




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