Potential of serious games as a competency assessment tool for acute care nurses on the blood transfusion procedure

Abstract

Background: Blood transfusion is a life-saving treatment that requires comprehensive knowledge and compliance to safety, administration, and management of blood transfusion process. It is a core competency for a registered nurse. Competency assessments are annually conducted as regulatory requirement and for quality assurance within our institution. Prior to using serious games, competency assessment involved an online learning module followed by a face-to-face assessment. This had limitations such as such as limited opportunities, potential lack of standardisation, time, and resources. Aim: The aim of this study was to assess whether serious game for blood transfusion administration could be a valid and reliable nursing competency assessment tool through capturing and analysis of in-game empirical data. Methods: The nursing department from Singapore General Hospital (SGH) developed a serious game for blood transfusion administration. The game modules were developed to match the actual procedure with established learning objectives at each stage. The game’s content validity was assessed by four external subject-matter-experts. Gameplay data of 1093 nurses were tested for construct validity, internal-consistency reliability, and criterion validity of the game. Results: The item-level content validity index (I-CVI) ranged between 0.75 and 1, while the average of the I-CVI scores for all items on the scale (S-CVI/Ave) was 0.99. Six factors and 82 game actions were obtained using principle factor analysis. Most game actions had a communality value (h2) above 0.5. The Inter-factor correlations between the six factors ranged from 0.2 to 0.45. Internal-consistency reliability estimates (α) (together with their 95% CIs) for the stages were greater than 0.75, with an overall of 0.96 for the 82 game actions. Linear association between each predictor and the criterion were below 0.25. Conclusion: Based on the empirical data collated, we conclude that the serious game may be a valid competency assessment tool for nurses in SGH. For future work, we propose to conduct the blood transfusion serious game in other hospitals to further support its validity and reliability as a competency tool for multi-step complex procedural clinical skills.