Gamification as a strategy in nursing clinical supervision for developing critical reflective thinking

This study aimed to analyse the benefits of a gamified clinical supervision strategy during hospital-based training, particularly regarding the development of critical and reflective thinking among undergraduate nursing students.

From April to July 2023, second-year nursing students who undertaking a nine-week clinical placement in a cardiology ward in northern Portugal were selected. Following a two-week diagnostic phase, students participated in a six-week gamified supervision programme comprising weekly 60-min sessions: infection-control decision-making; technical-procedural reasoning; guided emotional and ethical reflection; and clinical reasoning quiz on cardiology topics. Students completed weekly Structured Reflection Guide entries; supervisors recorded structured field notes after each session; and, after the intervention, students answered a post-intervention questionnaire and participated in focus groups. Qualitative data (reflections, field notes, open-ended questionnaire items, and focus-group transcripts) were analyzed using Bardin's content analysis; quantitative questionnaire items were summarized descriptively.

All seven students completed the six gamified sessions and submitted weekly reflection entries. Five students (71.4 %) completed the questionnaire. Across data sources, students reported that gamified activities supported knowledge consolidation, teamwork, and clinical reasoning. Questionnaire data showed that all respondents (n = 5, 100 %) strongly agreed that gamification enhanced their learning and should be maintained in clinical training. Reflections and focus groups revealed recurring themes related to emotional expression, sense of belonging, and difficulties using structured reflection tools, particularly in terms of comprehension and timing.

The gamified supervision strategy integrated into clinical training provided structured opportunities for practical engagement, collaborative work, and guided reflection. These findings suggest that gamification may support the development of reflective and critical-thinking processes in authentic clinical environments.