Effectiveness of game-based learning in mental health nursing education on self-directed learning and academic self-efficacy among nursing students.

Background

Traditional lecture-based teaching in nursing education often leads to limited student engagement, poor knowledge retention, and low self-confidence, particularly in complex fields such as mental health nursing, where students must navigate abstract clinical presentations and develop interpersonal skills that cannot be reduced to algorithmic protocols. Game-based learning (GBL) has emerged as an interactive strategy to enhance motivation, critical thinking, self-directed learning (SDL), and academic self-efficacy. This study aimed to evaluate the effectiveness of GBL integrated into a mental health nursing internship on SDL and academic self-efficacy among undergraduate nursing students.

Methods

A quasi-experimental, two-group, pretest-posttest design with a one-month follow-up was employed. Forty-six sixth-semester nursing students from Abadan University of Medical Sciences (Iran) were enrolled and allocated to an intervention group (n = 23) or a control group (n = 23) based on the pre-existing scheduling of their clinical internship rotations. After accounting for attrition, the final analytical sample comprised 40 participants (intervention: n = 20; control: n = 20). The intervention group received GBL integrated with standard instruction, while the control group received conventional internship training only. The intervention involved a custom-designed board game with scenario-based challenges delivered over 10 sessions (40 h total). Outcomes were measured using the Self-Directed Learning Readiness Scale (SDLRS) and the College Academic Self-Efficacy Scale (CASES) at pretest, posttest, and one-month follow-up. Data were analyzed using repeated measures ANOVA with Bonferroni-corrected pairwise comparisons for within-group changes, independent t-tests for between-group comparisons, and Cohen's d for effect sizes. A sensitivity analysis for attrition bias was conducted using a pattern-mixture model under best-case, worst-case, and intermediate imputation scenarios.

Results

Groups were homogeneous at baseline (P > 0.05 for all demographic and outcome variables). In the intervention group, repeated measures ANOVA revealed significant main effects of time for both SDL (F(2,38) = 38.74, P < 0.001, partial η²=0.67) and academic self-efficacy (F(2,38) = 42.51, P < 0.001, partial η²=0.69). Post-intervention, the GBL group showed significant improvements in SDL (mean difference: 16.25 ± 8.03, P < 0.001) and academic self-efficacy (mean difference: 12.50 ± 7.14, P < 0.001), with large effect sizes (Cohen's d = 1.25 and 1.56, respectively). These gains were maintained at the one-month follow-up, with no significant decline from posttest to follow-up (SDL: P = 0.784; self-efficacy: P = 0.821). The control group exhibited no significant changes across any time points (P > 0.05). Between-group differences were significant at posttest (SDL: P = 0.037, d = 0.68; self-efficacy: P = 0.029, d = 0.72) and at follow-up (SDL: P = 0.043, d = 0.66; self-efficacy: P = 0.034, d = 0.70). Sensitivity analyses confirmed that the findings were robust to plausible patterns of missing data due to attrition, with the treatment effect remaining significant even under worst-case imputation scenarios.

Conclusion

GBL integrated into a mental health nursing internship significantly enhanced SDL and academic self-efficacy, with effects sustained at one-month follow-up. These findings support the integration of game-based strategies into nursing curricula as a student-centered approach to bridge theory-practice gaps and foster durable self-regulatory capacities. Further research with larger samples, multi-site designs, and extended follow-up periods of six to twelve months is recommended to confirm the generalizability and long-term durability of these effects.