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Clinical reasoning skills, Game metrics, Nursing students, Simulation games, Virtual reality



  1. Havola, Sara RN, MNSc
  2. Haavisto, Elina RN, PhD, Prof
  3. Makinen, Henna RN, MNSc
  4. Engblom, Janne DSc, MSc
  5. Koivisto, Jaana-Maija RN, PhD


Research has shown that nursing students can learn clinical reasoning skills by engaging in simulation games. However, there has been no research regarding the effects of simulation games on clinical reasoning skills when nursing students also engage in virtual reality simulations. Furthermore, by engaging in simulation games, neither game metrics nor their impact on students' self-evaluated clinical reasoning skills has been studied. The purpose of this study was to evaluate the effects of these two kinds of simulation games using a one-group pretest-posttest design. Forty nursing students self-evaluated their clinical reasoning skills in three phases using the Clinical Reasoning Skills scale. Furthermore, the game metrics of the simulation games were analyzed, and the results clearly showed that students' self-evaluated clinical reasoning skills were systematically improved. There was a systematic association between better playing scores and better self-evaluated clinical reasoning skills in playing both kinds of simulation games. Moreover, students engaged more time in the virtual reality simulation than the computer-based simulation game. Overall, the results suggest that the use of a combination of both kinds of simulation games is an effective way for nursing students to learn clinical reasoning skills.