Effect Of Gamified Learning On Clinical Decision Making Among Undergraduate Nursing Students

Abstract

Background: Clinical decision-making is a core professional competency for nursing students, yet traditional lecture-based teaching often less effective to develop the active, judgment-oriented skills it demands. Game-based learning platforms such as Kahoot offer an interactive alternative, but evidence from Arab and Iraqi nursing programs is still limited. Methods: A two-group, pre-test/post-test quasi-experimental design was used at the Faculty of Nursing, University of Kufa, Iraq. Ninety-nine fourth-year undergraduate nursing students were allocated to a study group (n = 48), which received four weekly 90-minute Kahoot-based sessions, or a control group (n = 51), which received matched lecture-based teaching. The primary outcome was the Clinical Decision-Making in Nursing Scale (CDMNS); Cronbach's α in the present sample exceeded 0.85. Data were analyzed with descriptive statistics, chi-square, paired and independent-samples t-tests, ANOVA, and Cohen's d. Reporting follows the TREND statement for non randomized evaluations. Results: The two groups were comparable at baseline on all sociodemographic and educational variables (p > 0.05). After the intervention, the study group's CDMNS mean rose from 3.39 ± 0.33 to 3.78 ± 0.33 (t = 5.88, p < 0.001) with a large effect size (Cohen's d = 0.85), shifting the modal classification from moderate to strong. The control group did not change meaningfully (3.37 ± 0.35 to 3.39 ± 0.36; p = 0.753). Between-group post-test differences were highly significant in favor of the study group (t = 5.50, p < 0.001). Conclusion: Kahoot-based gamified learning produced large, statistically significant gains in clinical decision making compared with traditional lecture teaching and merits inclusion in undergraduate nursing curricula, particularly in resource-constrained settings.