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. 2025 May 27;24(1):602.
doi: 10.1186/s12912-025-03253-z.

Game on or game over? Gamification from 360-degree perspective, perception, confidence, and challenges in simulation based nursing education: mixed-method study

Mohamed Hashem Kotp  1 , Hasan Ahmed Awad Bassyouny  1 , Mohamed Ahmed Aly  1   2 , Rasha Kadri Ibrahim  3 , Abdelaziz Hendy  4 , Ahmed Shaaban Attia  5 , Ahmed Khalaf Mekdad  5 , Ahmed Ali Hafez  5 , Sally Mohammed Farghaly Abdelaliem  6 , Nadiah A Baghdadi  6 , Ahmed Hendy  7   8 , Hossam Ali Ismail  1
Affiliations

Game on or game over? Gamification from 360-degree perspective, perception, confidence, and challenges in simulation based nursing education: mixed-method study

Mohamed Hashem Kotp et al. BMC Nurs. .

Abstract

Background: Gamification has emerged as a transformative approach in nursing education, especially within simulation-based learning environments. It is recognized for enhancing student engagement, knowledge retention, and confidence. Despite its potential, limited research has explored the perceptions and confidence of nurse educators and students, as well as the challenges encountered during its implementation. The study aimed to assess the perceptions and confidence of nurse educators and nursing students towards integrating gamification into simulation-based nursing education, identify implementation barriers, and develop and validate two psychometric tools: the Gamification Perception Assessment Tool and the Nurse Educator Confidence Tool.

Methods: A convergent mixed-methods design was utilized, involving 115 nurse educators and 317 nursing students from eight nursing institutions in Cairo. Quantitative data were collected using the newly developed tools, which underwent rigorous validation through Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and reliability testing. Qualitative data were collected via semi-structured questionnaires and interviews with nurse educators and analyzed thematically to explore implementation challenges.

Results: The overall mean perception score was 34.8 ± 8.4 for nursing students and 36.3 ± 7.9 for nurse educators, with the majority of participants in both groups showing a high perception level (61.7% for educators and 58.9% for students). Nurse educators displayed moderate to high confidence, which was significantly influenced by their experience and prior training. A strong positive correlation (r = 0.711, p = 0.001) was found between perception and confidence. The psychometric tools demonstrated high reliability (Cronbach's α = 0.68-0.85) and model fit. Thematic analysis revealed barriers such as institutional policy gaps, limited IT support, and lack of training.

Conclusion: Gamification is positively perceived and fosters educator confidence in simulation-based nursing education. However, successful implementation requires institutional support, faculty training, and standardized evaluation tools to overcome existing challenges and optimize educational outcomes. The study provides validated tools and empirical insights into gamification in nursing education.

Clinical trial number: Not applicable.

Keywords: Educational technology; Gamification; Nursing education; Simulation training; Students.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Ethical Committee of the Faculty of Nursing at Helwan University (No. 41 − 19/5/2024). The study adhered to the principles of the Declaration of Helsinki. The questionnaires were shared with the study participants, clearly explaining the study’s purpose and the items included in the questionnaire. Written informed consent was obtained from all participants. They were informed about the privacy of their information, assured that the data would be used exclusively for scientific research purposes, and notified that participation was voluntary and the study was harmless. Participants had the right to refuse participation or withdraw from the study at any time. No identifying information was collected to ensure anonymity. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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