Nursing studies

Winning at teamwork and time management: how a board game is helping nursing students

Two nurse teachers found a fun way to focus on the serious business of clinical priorities

Two nurse teachers found a fun way to focus on the serious business of clinical priorities


With the evidence suggesting enjoyment is linked to learning, it was important to
design a game that dealt with real-life practice in a fun way.

Students at King’s College London (KCL) often approach clinical teachers, especially during their final placement, to ask how to prioritise their time and manage a caseload of patients.

This aspect of learning can be difficult to fulfil in the classroom but board games – which are increasingly being used in health professional education – can offer a partial solution.

Our original idea to help students and qualified nurses prioritise professional challenges was rather grand – we wanted to simulate the ward environment with actors and computerised manikins, but this proved overly ambitious in terms of space and resources.

Capturing ward complexity

Realising that a board game could recreate the complexity of a ward environment using fewer resources than a high-fidelity simulation, we set about designing what became the Priorities Game: getting your ward in order.

The game, which was introduced at KCL in May, can help players develop skills in communication, clinical reasoning, decision making, prioritisation, leadership, teamwork, delegation and admission and discharge processes.

It simulates a typical hospital ward and is a form of ‘collaborative gaming’, in which competition is not between players but with the game itself; if one person wins or loses, so do all.

‘It made me think about the individual skill sets in the nursing team, and how best to use these in a busy ward to ensure all aspects of patient care are carried out efficiently. Playing this game with nursing students at different stages enabled more experienced students to share their knowledge’

Third-year adult nursing student 

The game is for between four and eight players, with play lasting for about an hour. Players take on roles as members of staff, including ward manager, staff nurse and healthcare support worker, and must achieve a target number of admissions and discharges before the end of the shift, as well as managing ongoing patient care.


Cards require players to manage the unexpected alongside the routine.

As the game progresses, players pick up cards detailing different events that come up in day-to-day nursing practice, such as a crash call or a patient urgently needing to go to the bathroom. Nursing tasks need to be completed too.

Players employ higher-order thinking skills to analyse complex scenarios, synthesise information, weigh up priorities and decide on a course of action in a risk-free environment. They must collaborate to make decisions, prioritise duties and use their role-specific skills to complete patient care tasks.

The game is won or lost depending on how well players work together to complete a shift safely, including all necessary admissions and discharges.

Practical applications

As with any simulated learning experience, players are encouraged to reflect on the game once it is completed in a short, guided debrief. This provides an opportunity to consider the application of learning in practice and to share what has been learned.

Although the evidence on collaborative gaming does not show it definitively improves educational outcomes, it does show that learners enjoy the games and there is considerable evidence of a link between enjoyment and learning.

‘It’s useful playing with the third years – I come away learning so much about how to approach things in practice’

First-year adult nursing student

We wanted the game to be engaging and to raise people’s curiosity by juxtaposing the importance of prioritisation with a more satirical take on nursing. It was important not to lose the potential for fun, with the engagement that could result.

The game was produced by Focus Games – a board game development company with experience in creating educational board games. Working collaboratively with the company was rewarding, and there were some amusing moments; our request for the inclusion of a drug preparation room, described as ‘clean utility’, resulted in a room with a vacuum cleaner and mop being added to the board.

‘Teamwork was key to completing the game, which I liked, and the unpredictability of the action cards was fun and reflected practice’

Third-year adult nursing student

After tweaks were made to the original version to ensure it would function as planned, version two was piloted with a group of students. This revealed that more guidance was needed for players, and the students had some useful insights about the role of students and healthcare assistants in the real world, which could be incorporated into the task cards.


The final product.

The game was also played at an NHS trust with qualified staff and nursing students, with Focus Games using the feedback to produce a final version.

Educational benefits

Those who piloted the game felt it presented a credible reflection of the ward environment and was enjoyable to play. They recognised its educational benefits for pre-registration students and newly qualified nurses.

The innovation was supported in principle by the university, but securing funds was a challenge because the idea did not fit neatly into the usual funding streams.

Drawing up the contractual arrangement between KCL and Focus Games was also challenging because working with industry was a new venture, with no precedent on which to base contracts.

Tips for creating an educational board game

  • Creativity Students want educational experiences that prepare them to prioritise safely in the real world of nursing. Making this fun can help encourage the learning process
  • Be realistic Having started planning an ‘all-singing, all-dancing’ simulation we had to look at what was actually achievable with the available resources
  • Collaboration Adopting a collaborative approach, rather than competitive gaming, helps foster teamwork and improve communication skills 
  • Partnership working Partner up with a professional game manufacturer with expertise in this area and include students in the process
  • Innovation Be patient and tenacious – innovative ideas by their very nature often have no precedent to guide development and funding

 

While there is a clear desire on the part of institutions for innovative ideas and practice, difficulties can arise when these innovations have no precedent to guide procurement. Perhaps a separate funding stream and process for innovative ideas could help address this.

‘It’s like real life – you start off playing the game, taking your time with decisions and actions like you do on a shift, then it’s a mad rush at the end to complete all the tasks. It’s made me think more about my time management’

Third-year adult nursing student

Educational games could have a valuable role to play in the preparation and development of nurses. Although they are not a substitute for clinical experience, their ability to recreate practice scenarios with inherent tension allows players to practise clinical prioritisation and management in a risk-free context.

Further research is needed to understand the effects of educational games among nurses beyond their ability to engage players in a learning process.


 

 

Lucy Tyler is clinical nurse teacher, adult nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London

 

 

Rhiannon Eley is a former senior clinical teacher, adult nursing, King’s College London and founder and chief executive of Learn Share Care 


Further information

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