Serious Game-Assisted Teaching for Junior Operating Room Nurses in Unicompartmental Knee Arthroplasty:...

Unicompartmental knee arthroplasty (UKA) requires precise intraoperative coordination from operating room nurses. Conventional teaching may be insufficient for junior nurses learning complex UKA surgical cooperation, particularly regarding self-efficacy and cognitive demands. Serious games have emerged as a promising educational tool for nursing training.

This study evaluated whether adding a WeChat-based serious game to conventional UKA training was associated with improved theoretical knowledge, self-efficacy, preoperative preparation, intraoperative performance, and perceived cognitive load among junior operating room nurses.

This quasi-historical controlled study compared 2 sequential, noncontemporaneous cohorts of newly recruited junior operating room nurses from a tertiary hospital in Xuzhou, China. Nurses recruited in 2023 were assigned to the conventional training group (n=21, 50%), whereas nurses recruited in 2024 were assigned to the serious game-assisted training group (n=21, 50%). Both groups received the same UKA curriculum, including theoretical teaching and supervised intraoperative practice, while the intervention group additionally used a mobile serious game. Outcomes included theoretical test scores, General Self-Efficacy Scale scores, National Aeronautics and Space Administration Task Load Index (NASA-TLX) cognitive load scores, and assessments of preoperative preparation and intraoperative performance.

Data from all 42 eligible participants were included. Compared with conventional training, serious game-assisted training was associated with higher theoretical knowledge scores (mean 96.86, SD 3.09 vs mean 92.38, SD 4.32; P<.001; Cohen d=1.19), preoperative preparedness (mean 4.19, SD 0.33 vs mean 3.49, SD 0.29; P<.001; Cohen d=2.27), intraoperative performance (mean 4.00, SD 0.30 vs mean 3.41, SD 0.28; P<.001; Cohen d=2.03), and overall preparedness and performance (mean 4.10, SD 0.23 vs mean 3.45, SD 0.20; P<.001; Cohen d=3.02). Self-efficacy was higher in the unadjusted analysis (mean 34.05, SD 2.87 vs mean 31.57, SD 3.43; P=.02; Cohen d=0.78), but this difference was attenuated after adjustment for age and education (adjusted mean difference 2.45, 95% CI -0.26 to 5.15; P=.08). The serious game-assisted group also reported higher NASA-TLX total cognitive load (mean 65.44, SD 12.00 vs mean 58.21, SD 6.05; P=.02; Cohen d=0.76).

Serious game-assisted training was associated with better theoretical knowledge and procedural performance but higher perceived cognitive load among junior operating room nurses learning UKA coordination. The adjusted self-efficacy result, as well as the overall findings, should be interpreted cautiously rather than as definitive causal evidence because the study used a quasi-historical design without a contemporaneous control group.