Journal of Nursing Education

Syllabus Selections: Innovative Learning Activities Free

Using Jenga to Teach Risk Management Concepts to Senior Nursing Students

Tori Brown, EdD, RN

Have you ever taught a class or lecture content where you were not sure how to engage students? Or you were just uncertain of how to present content? Leadership and Management of Nursing Care could be one of those courses for some nurse educators. Leadership and Management of Nursing Care is a necessary course for baccalaureate-prepared nursing students. Given that this course is generally not associated with clinical or patient contact hours, it can be difficult for the students to grasp the information and/or find it engaging. Cresswell et al. (2013) stated that there are few opportunities for students to understand patient risks or how to deal with them. However, as educators prepare students to become nurses, it is imperative that the discussion surrounding risk management and quality improvement occur.

So, how can nurse educators make learning about risk management active, engaging, or just plain fun? The University of Scranton (n.d.) expressed that risk to patients and health care providers are prevalent in the health care setting. It is the duty of all health care staff to minimize exposure of risk toward all patients. Helping nursing students learn risk management in the form of a game or simulation called Patient Jenga® promotes an active learning environment, encourages critical thinking, stimulates team building, creates a fun teaching atmosphere, and replicates real-life patient scenarios.

Activity Description

One of the main objectives in the risk management unit for the course and activity was to describe the risk management interface with health care safety and performance improvement. Three patient case studies were prepared prior to class. Embedded in each case study were five to seven patient risks, including failure to respond in a timely manner, lack of documentation, team did not comply with emergency protocol, and more. The objective was to identify each risk without the Jenga tower toppling over. If the tower toppled over that symbolized the patient had expired. If a group's patient expired that group was no longer able to continue playing the game. The group who identified all or majority of the risks, in addition to keeping their patient alive, were the winners. Therefore, each group was responsible in identifying all the risks that could endanger the patient. The class size was approximately 80 students. This activity could also work with smaller classes.

The class was divided into the number of case studies available (i.e., three cases, three groups). Each group had 15 minutes to read the case study and determine their answers. Three Jenga games represented the three patients within each of the scenarios. Before the start of class, Jenga blocks were already set up. Jenga blocks were placed on flat surfaces and stacked in sets of three until towers 18 blocks high were built. Each new layer of three parallel blocks were rotated 90° along the horizontal axis from the last layer. At the start of the game, the exception was that each group provided careful and thoughtful responses to save their patient. Each block represented an answer. Whether the answer was correct or incorrect, one student was to come down to his or her Jenga patient and play Jenga as normally played: carefully take one block out from any level of the tower except the top and then the block is put back on top of the tower to continue the pattern of layering-by-threes stack.

The students provided thoughtful, meaningful, and analytical answers. The ultimate goal of the activity was for students to identify each risk before the patient was in complete danger. A thorough discussion of the risks within the case studies took place after completion of the game as a debriefing strategy. Each group identified appropriate interventions that could eliminate the risks that were present in the scenario. Additionally, evaluation forms were created to capture student perceptions of the activity and assess if their understanding of risk management was strengthened. The activity received excellent reviews (strongly agree and agree). One of the drawbacks for a few students was the large group sizes. However, the students loved the activity and wished every class lecture could be as engaging.

Tori Brown, EdD, RN
Winston Salem State University


  • Cresswell, K., Howe, A., Steven, A., Smith, P., Ashcroft, D., Fairhurst, K. & Sheikh, A. (2013). Patient safety in healthcare preregistration educational curricula: Multiple case study-based investigations of eight medicine, nursing, pharmacy and physiotherapy university courses. BMJ Quality and Safety, 22, 843–854. doi:10.1136/bmjqs-2013-001905 [CrossRef]
  • The University of Scranton. (n.d.). The purpose of risk management in healthcare. Retrieved from

The author has disclosed no potential conflicts of interest, financial or otherwise.


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