Educational outcomes of digital serious games in nursing education: a systematic review and meta-analysis of randomized controlled trials

Background: Advancements in digital technologies and the coronavirus disease pandemic have rapidly shifted educational practices towards engaging digital methods, such as serious games, significantly influencing healthcare education. Digital serious games enhance nursing education by effectively overcoming limitations such as limited training time and inadequate resources, thereby improving knowledge and skills. Few high-quality systematic reviews and meta-analyses were focused exclusively on randomized controlled trials (RCTs) of digital serious games to determine their effects in nursing education. Objective: To evaluate the effects of digital serious games on nursing education through a systematic review and meta-analysis using the Kirkpatrick model to evaluate learning and behavioral changes. Methods: A systematic review and meta-analysis of RCTs was performed. Six databases were searched for articles published before April 2024. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. A sensitivity analysis was performed. Outcome variables were categorized according to the Kirkpatrick model. Effect sizes were determined using Hedges’ g in a random-effects model. Subgroup analysis was performed. Results: The quality appraisal results revealed that all the studies exhibited a low risk of bias across these domains. Eleven studies were included in the systematic review, and eight studies, in the meta-analysis. The intervention group showed significant improvements in knowledge (Hedges’ g = 0.75, 95% confidence interval (CI) = [0.27, 1.22], p =.002, I² = 90.51%), confidence (Hedges’ g = 0.73, 95% CI = [0.23, 1.24], p =.005, I² = 82.71%), and performance (Hedges’ g = 0.49, 95% CI = [0.17, 0.80], p =.003, I² = 56.60%). Subgroup analysis showed a significant improvement in knowledge when the intervention period exceeded 2 weeks (Hedges’ g = 0.53, 95% CI = [0.32, 0.74], p <.001, I² = 25.41%). Conclusion: This study demonstrates that digital serious games significantly enhance knowledge, performance, and confidence of nursing students, offering a valuable alternative to traditional methods and equipping them with essential clinical competencies. However, the observed high heterogeneity and limitations like brief intervention durations necessitate caution in result interpretation and highlight the need for further research to explore long-term effects and behavioral changes in nursing education.