In recent years, teaching strategies such as filming, videotaping, computer-assisted programs, and gaming have been an integral part of the educational system. There has been a search for effective teaching strategies at all levels of education in an attempt to reinforce learning and motivate students to learn.
Review of the literature related to reinforcement and motivation reveals these concepts are interpreted differently depending upon which view of learning one explores. For some, the process of reinforcement places an emphasis on understanding (Bruner, 1966; Piaget, 1952). Others state reinforcement comes from interaction with others (Gagne', 1971; Bandura, 1974). Some stress reinforcement as a mechanical, automatic process (Thorndike, 1931; Skinner, 1958). Likewise, theorists differ in their view of motivation. While some view motivation as being externally activated, others feel that motivation has its origin within the individual (Bandura, 1974; Gagne, 1971; Spence, 1951). Regardless of what view one explores, most learning theorists draw a relationship between reinforcement and motivation, in that reinforcement can activate motivation or motivation can lead to reinforcement. In addition, review of the literature reveals not one interpretation of these concepts is applicable to all learners in all situations (Ericksen, 1974; Stephens, 1966). How knowledge is acquired and retained through utilization of specific teaching strategies has stimulated an interest in this author. As a result, this author has developed a board game and has tested its effectiveness as a means of reinforcement and motivation of learning.
Review of the literature reveals board gaming is often used in the education of younger children. For example, many games are available to reinforce and motivate learning of such topics as colors, number facts, etc. (Dunn & Dunn, 1972).
In higher education, board gaming is utilized particularly in the area of business to teach facts, as well as concepts (Taylor & Walford, 1972). However, review of the literature reveals very few games have been developed for nursing education to aid in the reinforcement and motivation of learning. Examples of such games include GUTS, a game designed to teach facts about the digestive system, and SuperSandwich, which is designed to teach nutrition facts (King, 1984).
The board game, developed by this author, relates to conceptual models of nursing. The intent of the game was to take a specific topic and develop a means by which learning of the subject matter could be reinforced, while at the same time motivating students to learn. In addition, it was hoped the game would be enjoyable for the students, as well, as enable the learner to compare one model with another; contrast models by identifying similarities and differences; generalize about the major concepts of nursing, i.e., person, environment, nursing and health; and categorize various conceptual models according to theme. Conceptual models of nursing were selected as the topic of this game as these models are taking on a new emphasis in nursing education and practice (NLN, 1984).
Advantages and Disadvantages of Gaming
Much has been written about the value of gaming in education. Taylor and Walford (1972) identify three major attributes of gaming:
1. Activity is provided in which both students and educator may participate.
2. It is very often problem oriented and helpful in the development of interdisciplinary approaches as well as often involves social skills which relate to the world outside the classroom, and
3. It is a technique which requires the learner to be flexible and to adapt to changing circumstances.
Clark (1976), Walljasper (1982) and King (1984) identify gaming as one classroom strategy that is useful in nursing education as a reinforcement and motivational tool. Clark (1976) states in nursing, gaming can be an effective teaching strategy that recreates elements of the actual nurse-patient relationship or other professional linkages. Walhasper (1982) points out that gaming encourages interaction among learners, increases learners' interest in a topic and increases learners' motivation.
These same authors also point out disadvantages of gaming. Because people differ in their learning styles, gaming might not be beneficial. Gaming creates a competitive environment. Some learners may be threatened by this competition and learning might be impeded. Gaming is also time consuming and, thus, the benefits of gaming must be weighed against the time need to achieve (Taylor & Walford. 1972; Clark, 1976; Walljasper, 1982; King, 1983).
Development of a Game
Clark (1976), Walljasper (1983) and King (1984) state that few games have been developed for use in nursing education. Therefore, educators must develop their own games. Clark (1976) suggests four criteria that educators should be aware of when developing a game:
1. The game should meet the learning objectives and needs of the student.
2. The game should fit within the existing curriculum of the educational institution.
3. The game should have a pretest/posttest which allows for evaluation of student learning.
4. The game should be field-tested for inconsistencies, unknowns and rule gaps when played (p. 9).
Design of Conceptual Models of Nursing Board Game
The game developed for learning of conceptual models of nursing is entitled "Cessario's Board Game." The objectives of the game include:
1. To enable the learner to compare, contrast, generalize and categorize conceptual models of nursing.
2. Tb encourage interaction between students and educator.
3. Tb provide learners with a teaching strategy that is enjoyable and makes learning fun.
The game is designed to be played individually or in groups of three or four. It can be utilized in any class size.
The game consists of a game board (Figure), a statement sheet related to conceptual models of nursing (Table), bingo chips, a pencil, and a box containing cards with questions and answers.
CESSARIOS BOARD GAME
EXAMPLE OF STATEMENT SHEET
The game board, similar to a bingo card, contains 25 squares, arranged in five columns down and five rows across. At the top of each column are the letters, N, I, S, C/N, E/F. These letters correspond to the themes in which conceptual models can be classified - Need-oriented, Interaction-oriented, Systems-oriented, Caring/Nurturing-oriented, and Environmental/Fieldoriented. Students are instructed to select any 25 statements they chose from the statement sheet. The statements, numbered 1 to 66, apply to specific conceptual models covered in classroom sessions. The object of the game is for the learner to decide to which general theme each statement relates. After the student makes his or her decision about the statement, the number that appears before each statement is recorded under the appropriate column of the game board. While completing the game board, students are encouraged to discuss the contents of the game with each other. After students have completed their game board, the instructor circulates to each student with a box containing cards. Each card contains a question and the answer relating to a particular conceptual model. The answer to the question corresponds to a statement on the statement sheet. As the student reads the question and the answer aloud, he or she also reads the correct number and theme of the corresponding statement as it appears on the selected card. If a student has placed the statement number under the correct theme on the game board, a bingo chip is placed on that number. The first student, or group of students, to complete a straight line either vertically, horizontally or diagonally is the winner.
To determine if there were any inconsistencies, unknowns and/or rule gaps when played, this game was field-tested utilizing 12 graduate students who had taken a course dealing with conceptual models of nursing. During this time, any statements which were ambiguous and inappropriate were reworded or deleted. The game took approximately one hour to complete.
It was interesting to watch the group dynamics during the gaming session. Students became very energetic and enthusiastic. Much discussion developed between students. As statements relating to conceptual models were examined, students gave their rationale for their choices.
The debriefing portion of the gaming session, when the winner(s) were determined, provided an opportunity for the teacher to review conceptual models of nursing with the students. Questions raised by the students were discussed.
To further evaluate the usefulness of this game, a study was conducted utilizing a quasi-experimental design.
The sample consisted of 23 undergraduate and graduate nursing students enrolled in courses dealing with conceptual models of nursing. Since these courses at both the undergraduate and graduate level emphasize conceptual models of nursing, subjects from both levels of education were utilized. Subjects were randomly assigned to a control or experimental group by drawing a number from a bag. If the number drawn was odd, the subject was in the control group. If the number drawn was even, the subject was in the experimental group. Fourteen students comprised the control group (ten from the undergraduate level and four from the graduate level). These students attended regular class sessions. The experimental group, comprised of nine students (six from the undergraduate level and three from the graduate level), in addition to class instruction, played the board game on two occasions.
A preteet/posttest, developed for determining level of knowledge, consisted of 29 multiple choice questions, related to conceptual models of nursing. These questions reflected course content. Course texts and course outlines were used to construct the test. It was tested for reliability by administering it twice, two weeks apart to five graduate students, who had formerly taken a course dealing with conceptual models of nursing and reliability was .94. It was examined for construct validity by a panel of four instructors, who had previously taught a course in conceptual models of nursing. This panel determined the test was accurate and reflected course content.
The pretest was administered to all students. The experimental group played the board game twice, one week apart. Each gaming session, conducted by this author, lasted 90 minutes. Since all subjects were not available at the same time, each gaming session was held at four different times on the same day.
The posttest was administered three weeks after the pretest to both the control and experimental groups. In addition, at this time, a questionnaire related to experimental group subjects' opinions of playing the board game was administered. This questionnaire asked if a subject felt motivated to learn about a particular model(s) after playing the game; if the board game reinforced his or her learning of conceptual models; if the subject enjoyed the game, and, if the subject felt this board game should be included in course content. To each of these items a subject responded "very much," "somewhat," or "not at all."
In order to maintain anonymity of subjects and instructors, all data was treated as aggregate data. Although the results of this study cannot be generalized to the population, due to the limited size of the sample, there were some interesting findings.
To determine if there was a significant difference in the post-test scores of those subjects who played the board game, analysis of variance was computed. Results indicated that the experimental group performed significantly higher at the p<.05 level than the control group on the total score. To determine if the board game motivated and reinforced learning, as reported by subjects of the experimental group, percentages of responses to the board game questionnaire were computed. Results indicated that all subjects of the experimental group reported the game to motivate and reinforce their learning as well as being enjoyable. In addition, all subjects felt the board game should be included in course content.
Gaming can be an effective teaching strategy for reinforcing and motivating students to learn. Development of the game discussed in this article is not intended to replace classroom instruction. Instead, it is intended to augment course content.
Board gaming can make learning a pleasant experience. It provides students and educators an opportunity to interact in an informal atmosphere and provides enjoyment, while at the same time may promote learning. Therefore, educators should consider further development of games for use with students in nursing education.
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CESSARIOS BOARD GAME
EXAMPLE OF STATEMENT SHEET