Effect of a simulation game on nursing students' reflective thinking skills: a mixed methods study.

Background: This study aimed to investigate the effect of a simulation game called "The Ward" on reflective thinking skills of senior nursing students.

Methods: A convergent mixed methods parallel research design was conducted between February-April 2018. The sample for this study was a convenience sample (n = 23) of senior nursing students. Student Information Form, Reflective Thinking Scale and a structured interview form were used as data collection tools. During study, simulation game was played once a week for seven weeks. Descriptive statistics (frequency, percentage, mean) were used for analyzing data, t test for dependent groups tests were applied to determine differences within group and qualitative data was analyzed with content analysis.

Results: After playing the simulation game, nursing students' reflective thinking scores (pre-test = 39.70 ± 5.15; post-test = 67.39 ± 8.13) increased significantly (p < 0.05). It was found students noticed their shortcomings and mislearnings by comparing their existing knowledge in setting of teamwork and cooperation created by the game, and consequently students' motivation increased or decreased. The teamwork and collaboration created with in the simulation game caused students to gain self-confidence, to expand their perspectives, to develop effective decision-making skills, to increase their motivation, to discover their own incomplete knowledge, skills or mislearnings.

Conclusions: These results support that the simulation games can be used to improve reflective thinking level of students. This finding shows that nursing education curriculum needs to be restructured using new methods such as simulation games aimed at improving students' reflective thinking skills. In this direction nurse educators should be involved with policy making and policy makers to develop strategies to ensure that graduated nursing students should gain reflective thinking skills. In addition nurse executives should encourage using simulation and simulation games in service training to improve nurses' reflective thinking skills and life long learning.